| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,930 |
2,359 |
$391K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,626 |
1,243 |
$171K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
225 |
152 |
$0.00 |
| D0270 |
|
147 |
143 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
173 |
167 |
$0.00 |
| D1120 |
Prophylaxis - child |
192 |
190 |
$0.00 |
| D9110 |
|
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
48 |
46 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
37 |
28 |
$0.00 |
| D1110 |
Prophylaxis - adult |
29 |
28 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
62 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
158 |
155 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
247 |
238 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
114 |
109 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,234 |
795 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
250 |
237 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
194 |
91 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
29 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
103 |
101 |
$0.00 |
| D0602 |
|
47 |
45 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
18 |
18 |
$0.00 |