| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92522 |
|
1,848 |
1,477 |
$104K |
| 96156 |
|
953 |
651 |
$46K |
| D0160 |
|
854 |
724 |
$37K |
| 96116 |
|
418 |
373 |
$27K |
| D9420 |
|
295 |
244 |
$24K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
457 |
383 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
692 |
646 |
$17K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
311 |
231 |
$13K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
396 |
361 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
39 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
27 |
$10K |
| D4355 |
|
100 |
98 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
153 |
148 |
$6K |
| 92567 |
|
207 |
187 |
$3K |
| D1206 |
Topical application of fluoride varnish |
116 |
112 |
$755.10 |