| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,607 |
2,580 |
$441K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,809 |
1,467 |
$152K |
| D1110 |
Prophylaxis - adult |
242 |
232 |
$246.00 |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
71 |
$180.60 |
| D0140 |
Limited oral evaluation - problem focused |
155 |
136 |
$32.40 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,223 |
1,005 |
$32.00 |
| D0120 |
Periodic oral evaluation - established patient |
323 |
311 |
$28.00 |
| 96127 |
|
567 |
407 |
$6.00 |
| D0220 |
Intraoral - periapical first radiographic image |
421 |
405 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
514 |
343 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
80 |
77 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
21 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
348 |
338 |
$0.00 |
| D9920 |
|
214 |
168 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
228 |
170 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$0.00 |
| D1330 |
|
53 |
43 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
69 |
$0.00 |