| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,644 |
2,357 |
$279K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,669 |
2,532 |
$224K |
| D1110 |
Prophylaxis - adult |
2,697 |
1,835 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
2,979 |
1,991 |
$138K |
| D0140 |
Limited oral evaluation - problem focused |
2,362 |
1,128 |
$92K |
| D1120 |
Prophylaxis - child |
1,508 |
1,127 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,248 |
599 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,001 |
803 |
$25K |
| D0274 |
Bitewings - four radiographic images |
722 |
618 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
302 |
211 |
$19K |
| 96127 |
|
653 |
181 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
381 |
381 |
$6K |
| 0012A |
|
156 |
156 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
48 |
$5K |
| 0011A |
|
166 |
166 |
$4K |
| 36415 |
Collection of venous blood by venipuncture |
416 |
323 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
207 |
205 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
26 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
71 |
56 |
$2K |
| 99000 |
|
131 |
62 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
15 |
$2K |
| 0064A |
|
40 |
40 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
14 |
12 |
$1K |
| 99051 |
|
130 |
126 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$1K |
| D0601 |
|
293 |
255 |
$976.04 |
| D0603 |
|
323 |
290 |
$675.72 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
34 |
34 |
$567.88 |
| D0602 |
|
35 |
13 |
$525.56 |
| 86701 |
|
32 |
12 |
$479.57 |
| 90686 |
|
25 |
19 |
$454.24 |
| 92551 |
|
36 |
36 |
$291.42 |
| 90688 |
|
14 |
14 |
$258.58 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
13 |
13 |
$162.89 |
| 99173 |
|
48 |
48 |
$94.17 |
| D1999 |
|
17 |
16 |
$0.00 |
| D1310 |
|
149 |
149 |
$0.00 |