| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,501 |
2,370 |
$119K |
| T1015 |
Clinic visit/encounter, all-inclusive |
5,317 |
3,814 |
$97K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,072 |
2,471 |
$81K |
| D0330 |
Panoramic radiographic image |
660 |
575 |
$24K |
| D1110 |
Prophylaxis - adult |
952 |
816 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
561 |
488 |
$11K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
613 |
332 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
100 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
608 |
519 |
$8K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
543 |
374 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
229 |
212 |
$5K |
| 80061 |
Lipid panel |
548 |
395 |
$3K |
| 84443 |
Thyroid stimulating hormone (TSH) |
401 |
272 |
$3K |
| 80053 |
Comprehensive metabolic panel |
528 |
388 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
570 |
385 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
416 |
193 |
$2K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
566 |
387 |
$2K |
| D0272 |
Bitewings - two radiographic images |
211 |
188 |
$2K |
| 84439 |
|
430 |
284 |
$1K |
| D1120 |
Prophylaxis - child |
85 |
57 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
936 |
658 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
72 |
54 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
14 |
$820.80 |
| D2140 |
|
18 |
12 |
$756.00 |
| D1206 |
Topical application of fluoride varnish |
100 |
82 |
$723.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
13 |
$468.57 |
| 99406 |
|
70 |
35 |
$292.33 |
| 90756 |
|
56 |
48 |
$266.89 |
| 90656 |
|
58 |
19 |
$0.00 |