| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 00003 |
Internal/system code - not a standard HCPCS code |
5,782 |
4,671 |
$3.37M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,587 |
1,441 |
$655K |
| 90832 |
Psychotherapy, 30 minutes with patient |
122 |
112 |
$49K |
| T1015 |
Clinic visit/encounter, all-inclusive |
169 |
140 |
$42K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
16 |
$7K |
| 0002A |
|
18 |
13 |
$667.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
540 |
295 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
229 |
229 |
$0.00 |
| D1320 |
|
28 |
28 |
$0.00 |
| D1330 |
|
26 |
26 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
929 |
878 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
215 |
137 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
39 |
39 |
$0.00 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$0.00 |