| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,960 |
3,694 |
$595K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,030 |
1,240 |
$219K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
877 |
582 |
$95K |
| 99441 |
|
660 |
539 |
$55K |
| D1110 |
Prophylaxis - adult |
1,230 |
786 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,693 |
779 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
753 |
480 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,248 |
725 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
180 |
131 |
$8K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
76 |
51 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
478 |
374 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
134 |
82 |
$7K |
| D1120 |
Prophylaxis - child |
289 |
161 |
$4K |
| 99442 |
|
38 |
31 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
139 |
60 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
652 |
600 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
21 |
12 |
$1K |
| 99443 |
|
14 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
301 |
298 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
30 |
$100.10 |
| D0270 |
|
12 |
12 |
$47.37 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$22.44 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$12.72 |
| D1330 |
|
39 |
39 |
$0.00 |