| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,651 |
2,380 |
$1.26M |
| D1206 |
Topical application of fluoride varnish |
1,888 |
1,845 |
$350K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
398 |
397 |
$212K |
| D1120 |
Prophylaxis - child |
574 |
574 |
$194K |
| D0140 |
Limited oral evaluation - problem focused |
475 |
452 |
$153K |
| 0011A |
|
211 |
210 |
$99K |
| 0012A |
|
193 |
190 |
$99K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
158 |
153 |
$98K |
| 0071A |
|
158 |
158 |
$90K |
| 0072A |
|
134 |
133 |
$84K |
| 0001A |
|
144 |
144 |
$79K |
| 0052A |
|
127 |
126 |
$76K |
| W0037 |
|
2,128 |
2,128 |
$71K |
| 0002A |
|
118 |
118 |
$63K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
126 |
126 |
$56K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
153 |
145 |
$54K |
| D1110 |
Prophylaxis - adult |
171 |
170 |
$51K |
| D1351 |
Sealant - per tooth |
570 |
170 |
$47K |
| 0051A |
|
62 |
62 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
333 |
304 |
$31K |
| 90834 |
Psychotherapy, 45 minutes with patient |
14 |
12 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$6K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$910.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$0.00 |