| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,130 |
890 |
$131K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
186 |
180 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
129 |
117 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
39 |
$9K |
| D1120 |
Prophylaxis - child |
37 |
34 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
32 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
30 |
$5K |
| D1351 |
Sealant - per tooth |
210 |
29 |
$4K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$757.84 |
| D1206 |
Topical application of fluoride varnish |
90 |
85 |
$189.46 |
| 36415 |
Collection of venous blood by venipuncture |
58 |
54 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
74 |
62 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$0.00 |
| 90656 |
|
29 |
29 |
$0.00 |