| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,386 |
3,095 |
$541K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,018 |
879 |
$103K |
| 99205 |
Prolong outpt/office vis |
41 |
30 |
$296.40 |
| 96127 |
|
2,305 |
1,641 |
$40.00 |
| 36415 |
Collection of venous blood by venipuncture |
647 |
516 |
$16.40 |
| D0120 |
Periodic oral evaluation - established patient |
108 |
105 |
$16.20 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
667 |
508 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,694 |
1,230 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
86 |
85 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
187 |
170 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
32 |
32 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
41 |
36 |
$0.00 |
| 0503F |
|
72 |
54 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
187 |
184 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
163 |
92 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
32 |
$0.00 |
| 0500F |
|
34 |
32 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
282 |
272 |
$0.00 |
| 0502F |
|
608 |
420 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
203 |
171 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
190 |
129 |
$0.00 |
| 81002 |
|
299 |
248 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
92 |
92 |
$0.00 |
| D1120 |
Prophylaxis - child |
39 |
39 |
$0.00 |
| 81025 |
|
27 |
26 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
49 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
167 |
151 |
$0.00 |