| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
507 |
463 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
449 |
437 |
$10K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
158 |
146 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
107 |
102 |
$4K |
| D1110 |
Prophylaxis - adult |
144 |
144 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
559 |
529 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
29 |
$2K |
| D1330 |
|
293 |
287 |
$2K |
| D0330 |
Panoramic radiographic image |
33 |
32 |
$2K |
| D0274 |
Bitewings - four radiographic images |
432 |
422 |
$1K |
| D1206 |
Topical application of fluoride varnish |
273 |
268 |
$907.82 |
| D0220 |
Intraoral - periapical first radiographic image |
733 |
707 |
$547.91 |
| D0140 |
Limited oral evaluation - problem focused |
55 |
54 |
$298.92 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$90.42 |
| 1159F |
|
235 |
219 |
$0.00 |
| 3725F |
|
646 |
419 |
$0.00 |
| 1160F |
|
216 |
204 |
$0.00 |
| 3078F |
|
339 |
236 |
$0.00 |
| 3077F |
|
44 |
29 |
$0.00 |
| D0180 |
|
30 |
30 |
$0.00 |
| 3008F |
|
1,087 |
720 |
$0.00 |
| 96127 |
|
506 |
302 |
$0.00 |
| 3074F |
|
442 |
416 |
$0.00 |
| 1036F |
|
856 |
563 |
$0.00 |
| 1125F |
|
110 |
99 |
$0.00 |
| D9310 |
|
61 |
61 |
$0.00 |
| 3075F |
|
36 |
36 |
$0.00 |
| 1126F |
|
149 |
125 |
$0.00 |
| 3079F |
|
289 |
191 |
$0.00 |
| 3080F |
|
25 |
14 |
$0.00 |