| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,385 |
2,226 |
$218K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,091 |
1,000 |
$63K |
| 99215 |
Prolong outpt/office vis |
194 |
193 |
$29K |
| D1110 |
Prophylaxis - adult |
269 |
255 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
164 |
151 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
66 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
113 |
106 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
199 |
185 |
$3K |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$467.52 |
| D1330 |
|
339 |
322 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$0.00 |