| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
10,348 |
7,269 |
$1.20M |
| 99443 |
|
79 |
71 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,090 |
934 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
52 |
49 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
341 |
308 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
53 |
30 |
$0.00 |
| D1330 |
|
255 |
177 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
45 |
$0.00 |
| D1310 |
|
255 |
177 |
$0.00 |
| 90686 |
|
18 |
18 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
46 |
26 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
24 |
$0.00 |
| 91301 |
|
62 |
60 |
$0.00 |
| 0011A |
|
41 |
40 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,047 |
711 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
321 |
264 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
244 |
213 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
63 |
57 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
13 |
$0.00 |
| 99442 |
|
48 |
42 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
35 |
30 |
$0.00 |