| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,104 |
980 |
$134K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,127 |
1,027 |
$93K |
| D0330 |
Panoramic radiographic image |
108 |
105 |
$14K |
| D0274 |
Bitewings - four radiographic images |
166 |
151 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
108 |
91 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
239 |
215 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
55 |
52 |
$5K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
13 |
$2K |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
12 |
$468.50 |
| 80305 |
|
14 |
13 |
$162.76 |