| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,781 |
1,331 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
781 |
183 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
899 |
815 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
329 |
298 |
$11K |
| D0330 |
Panoramic radiographic image |
532 |
499 |
$10K |
| D1110 |
Prophylaxis - adult |
306 |
275 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
73 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
372 |
294 |
$7K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
487 |
440 |
$7K |
| 97803 |
|
419 |
363 |
$6K |
| D1206 |
Topical application of fluoride varnish |
242 |
226 |
$5K |
| 90734 |
|
81 |
57 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
167 |
159 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
26 |
$2K |
| 99201 |
|
135 |
123 |
$2K |
| D0274 |
Bitewings - four radiographic images |
211 |
194 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
270 |
247 |
$2K |
| 99215 |
Prolong outpt/office vis |
52 |
32 |
$2K |
| D1120 |
Prophylaxis - child |
47 |
46 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
123 |
25 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
188 |
146 |
$1K |
| 90686 |
|
77 |
64 |
$926.57 |
| D0230 |
Intraoral - periapical each additional radiographic image |
88 |
57 |
$257.42 |
| D0270 |
|
14 |
13 |
$141.84 |
| 81025 |
|
12 |
12 |
$46.06 |
| 3074F |
|
82 |
68 |
$20.00 |
| 2000F |
|
785 |
608 |
$0.02 |
| 2010F |
|
955 |
740 |
$0.02 |
| 2001F |
|
852 |
649 |
$0.02 |
| 3008F |
|
832 |
648 |
$0.02 |
| 1036F |
|
88 |
66 |
$0.00 |
| 3351F |
|
82 |
69 |
$0.00 |
| 1170F |
|
19 |
17 |
$0.00 |
| 1034F |
|
34 |
25 |
$0.00 |
| 1126F |
|
18 |
13 |
$0.00 |
| 3078F |
|
13 |
12 |
$0.00 |
| 1159F |
|
697 |
550 |
$0.00 |
| 1160F |
|
697 |
550 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
13 |
$0.00 |
| 4274F |
|
359 |
212 |
$0.00 |