| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
Emergency department visit for the evaluation and management, high severity |
1,404 |
1,387 |
$57K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
179 |
175 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
234 |
226 |
$12K |
| D0330 |
Panoramic radiographic image |
425 |
423 |
$6K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
148 |
145 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
487 |
295 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
785 |
759 |
$4K |
| D1110 |
Prophylaxis - adult |
345 |
344 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
309 |
304 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
151 |
119 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
635 |
604 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
48 |
40 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
262 |
260 |
$884.70 |
| D0274 |
Bitewings - four radiographic images |
77 |
75 |
$651.36 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
13 |
$255.68 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
137 |
134 |
$87.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
28 |
$87.18 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
24 |
24 |
$28.51 |
| 99072 |
|
14 |
14 |
$5.28 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
56 |
$0.00 |
| D4341 |
|
33 |
17 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$0.00 |