| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92508 |
Group treatment of speech, language, voice, communication, and/or auditory processing disorder |
1,773 |
761 |
$29K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
381 |
368 |
$18K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
248 |
242 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
588 |
568 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
464 |
449 |
$6K |
| D1110 |
Prophylaxis - adult |
210 |
209 |
$5K |
| 92523 |
|
40 |
40 |
$4K |
| D1120 |
Prophylaxis - child |
149 |
149 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
67 |
45 |
$2K |
| D0272 |
Bitewings - two radiographic images |
100 |
100 |
$1K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
16 |
16 |
$896.00 |
| D0274 |
Bitewings - four radiographic images |
65 |
65 |
$859.20 |
| 92567 |
|
112 |
82 |
$728.00 |
| 92551 |
|
38 |
38 |
$567.00 |
| 99384 |
|
15 |
13 |
$504.00 |
| 92593 |
|
27 |
25 |
$378.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$294.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$160.00 |
| 92587 |
|
19 |
19 |
$80.00 |