| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,243 |
1,166 |
$83K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
720 |
688 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
831 |
202 |
$17K |
| D0274 |
Bitewings - four radiographic images |
271 |
236 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
345 |
287 |
$9K |
| D1110 |
Prophylaxis - adult |
64 |
62 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
46 |
45 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
17 |
17 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
16 |
16 |
$2K |
| 92015 |
Determination of refractive state |
16 |
16 |
$82.56 |