| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,566 |
1,371 |
$115K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,121 |
980 |
$70K |
| D1110 |
Prophylaxis - adult |
390 |
382 |
$16K |
| D0330 |
Panoramic radiographic image |
496 |
363 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
502 |
191 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
404 |
303 |
$8K |
| 80305 |
|
557 |
398 |
$6K |
| 3008F |
|
1,052 |
953 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
95 |
89 |
$4K |
| 90834 |
Psychotherapy, 45 minutes with patient |
39 |
25 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
185 |
181 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
214 |
172 |
$3K |
| D0274 |
Bitewings - four radiographic images |
189 |
188 |
$3K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
448 |
416 |
$3K |
| D1120 |
Prophylaxis - child |
82 |
82 |
$3K |
| D1206 |
Topical application of fluoride varnish |
136 |
135 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
505 |
397 |
$2K |
| 99000 |
|
1,329 |
1,148 |
$2K |
| 96127 |
|
420 |
364 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
31 |
27 |
$2K |
| 90791 |
Psychiatric diagnostic evaluation |
12 |
12 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
1,055 |
943 |
$1K |
| 90674 |
|
53 |
50 |
$998.41 |
| D0230 |
Intraoral - periapical each additional radiographic image |
274 |
122 |
$681.98 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
168 |
153 |
$267.29 |
| 90756 |
|
13 |
12 |
$83.38 |
| 36416 |
|
476 |
443 |
$36.26 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
79 |
74 |
$0.00 |
| G8511 |
Screening for depression documented as positive, follow-up plan not documented, reason not given |
111 |
100 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
13 |
13 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
134 |
126 |
$0.00 |