| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,039 |
4,919 |
$1.22M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
355 |
315 |
$108.84 |
| D1120 |
Prophylaxis - child |
50 |
42 |
$0.00 |
| 1159F |
|
161 |
155 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
83 |
82 |
$0.00 |
| D1110 |
Prophylaxis - adult |
157 |
138 |
$0.00 |
| D9110 |
|
43 |
43 |
$0.00 |
| 3078F |
|
59 |
54 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
46 |
46 |
$0.00 |
| D1999 |
|
30 |
30 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
212 |
191 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19 |
13 |
$0.00 |
| 3074F |
|
130 |
127 |
$0.00 |
| 3008F |
|
194 |
181 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$0.00 |
| 2001F |
|
105 |
99 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |
| 1111F |
|
29 |
29 |
$0.00 |
| D5899 |
|
18 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
27 |
15 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
12 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$0.00 |