| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,598 |
4,814 |
$905K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,649 |
1,422 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
928 |
873 |
$238.33 |
| D0120 |
Periodic oral evaluation - established patient |
128 |
128 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
51 |
50 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
59 |
54 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
131 |
131 |
$0.00 |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
66 |
57 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
232 |
232 |
$0.00 |
| 3074F |
|
17 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
77 |
77 |
$0.00 |
| D0330 |
Panoramic radiographic image |
66 |
66 |
$0.00 |
| 98940 |
|
93 |
53 |
$0.00 |
| D1120 |
Prophylaxis - child |
166 |
166 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
160 |
146 |
$0.00 |
| D1110 |
Prophylaxis - adult |
342 |
339 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
195 |
194 |
$0.00 |