| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
971 |
771 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
417 |
393 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
25 |
$7K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
153 |
126 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
316 |
293 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
120 |
104 |
$3K |
| D1110 |
Prophylaxis - adult |
52 |
50 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
69 |
66 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
61 |
51 |
$2K |
| D1206 |
Topical application of fluoride varnish |
62 |
59 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
21 |
19 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
26 |
25 |
$144.69 |