| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
327 |
252 |
$19K |
| D1110 |
Prophylaxis - adult |
219 |
152 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
145 |
128 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
164 |
113 |
$6K |
| D0274 |
Bitewings - four radiographic images |
75 |
61 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
67 |
65 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
72 |
55 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
39 |
$694.98 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$358.20 |