| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,561 |
8,759 |
$6.12M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,843 |
2,314 |
$1.57M |
| D0220 |
Intraoral - periapical first radiographic image |
1,154 |
1,058 |
$508K |
| D1120 |
Prophylaxis - child |
751 |
716 |
$360K |
| D1110 |
Prophylaxis - adult |
1,730 |
1,560 |
$339K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
416 |
342 |
$215K |
| D0140 |
Limited oral evaluation - problem focused |
358 |
342 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
368 |
242 |
$96K |
| D0330 |
Panoramic radiographic image |
447 |
397 |
$84K |
| D1206 |
Topical application of fluoride varnish |
830 |
784 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
953 |
898 |
$71K |
| 0012A |
|
100 |
92 |
$69K |
| 36415 |
Collection of venous blood by venipuncture |
324 |
267 |
$67K |
| 0011A |
|
110 |
91 |
$65K |
| 99215 |
Prolong outpt/office vis |
99 |
79 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
410 |
362 |
$46K |
| 90834 |
Psychotherapy, 45 minutes with patient |
167 |
83 |
$39K |
| D0274 |
Bitewings - four radiographic images |
918 |
853 |
$30K |
| 90837 |
Psychotherapy, 53 minutes with patient |
61 |
40 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
174 |
145 |
$13K |
| 0031A |
|
27 |
20 |
$13K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
42 |
26 |
$10K |
| D0272 |
Bitewings - two radiographic images |
68 |
65 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
16 |
13 |
$9K |
| 90832 |
Psychotherapy, 30 minutes with patient |
27 |
14 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
26 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,375 |
713 |
$4K |
| 92015 |
Determination of refractive state |
20 |
13 |
$0.00 |