| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,145 |
2,064 |
$176K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,296 |
1,244 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
233 |
98 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
289 |
287 |
$11K |
| D1110 |
Prophylaxis - adult |
226 |
226 |
$10K |
| 36415 |
Collection of venous blood by venipuncture |
1,376 |
1,313 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
137 |
137 |
$4K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$2K |
| 96127 |
|
147 |
130 |
$502.65 |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$478.48 |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$180.05 |