| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
20,986 |
16,255 |
$2.76M |
| 90832 |
Psychotherapy, 30 minutes with patient |
3,359 |
1,708 |
$519K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,890 |
1,489 |
$248K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,054 |
1,293 |
$217K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
842 |
564 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,792 |
604 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
1,378 |
563 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
676 |
349 |
$45K |
| D9996 |
|
630 |
262 |
$40K |
| D0180 |
|
1,071 |
240 |
$31K |
| D1110 |
Prophylaxis - adult |
662 |
261 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
227 |
132 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
843 |
248 |
$27K |
| 97803 |
|
129 |
123 |
$23K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
192 |
136 |
$20K |
| 97802 |
|
95 |
94 |
$18K |
| 99442 |
|
86 |
78 |
$14K |
| D0170 |
|
190 |
83 |
$13K |
| D0601 |
|
337 |
47 |
$8K |
| D0274 |
Bitewings - four radiographic images |
222 |
139 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
416 |
391 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
28 |
24 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
33 |
25 |
$4K |
| 99441 |
|
18 |
18 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
256 |
229 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
25 |
14 |
$3K |
| 99385 |
|
23 |
12 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
13 |
13 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$2K |
| D0431 |
|
104 |
102 |
$223.28 |
| D0190 |
|
18 |
13 |
$178.25 |
| D1330 |
|
37 |
37 |
$0.00 |
| D0602 |
|
25 |
25 |
$0.00 |
| D1310 |
|
24 |
24 |
$0.00 |