| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 3037F |
|
2,101 |
1,239 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
252 |
248 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
47 |
47 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,770 |
742 |
$996.44 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,064 |
541 |
$776.09 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$630.80 |
| D1330 |
|
211 |
209 |
$527.22 |
| D0274 |
Bitewings - four radiographic images |
160 |
158 |
$347.62 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
175 |
161 |
$215.64 |
| D1208 |
Topical application of fluoride, excluding varnish |
101 |
100 |
$151.00 |
| D0220 |
Intraoral - periapical first radiographic image |
173 |
171 |
$142.24 |
| D1120 |
Prophylaxis - child |
74 |
73 |
$142.00 |
| 3008F |
|
3,180 |
1,447 |
$93.46 |
| 3078F |
|
1,250 |
785 |
$32.56 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
175 |
149 |
$9.77 |
| 1160F |
|
1,398 |
678 |
$0.00 |
| 92552 |
|
13 |
13 |
$0.00 |
| 3077F |
|
41 |
37 |
$0.00 |
| 1159F |
|
839 |
166 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
15 |
15 |
$0.00 |
| 99173 |
|
13 |
13 |
$0.00 |
| 3075F |
|
183 |
106 |
$0.00 |
| 3074F |
|
1,375 |
845 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
123 |
121 |
$0.00 |
| 3079F |
|
460 |
244 |
$0.00 |