| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,045 |
2,736 |
$714K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,052 |
846 |
$419K |
| 90834 |
Psychotherapy, 45 minutes with patient |
352 |
105 |
$120K |
| 90832 |
Psychotherapy, 30 minutes with patient |
284 |
128 |
$92K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
157 |
143 |
$32K |
| D1110 |
Prophylaxis - adult |
214 |
157 |
$15K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
68 |
66 |
$684.00 |
| D0140 |
Limited oral evaluation - problem focused |
147 |
142 |
$643.33 |
| 0011A |
|
13 |
13 |
$520.00 |
| D0220 |
Intraoral - periapical first radiographic image |
109 |
103 |
$493.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
15 |
$356.00 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$168.00 |
| D0180 |
|
12 |
12 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
12 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$0.00 |