| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18,276 |
11,929 |
$1.46M |
| D0120 |
Periodic oral evaluation - established patient |
12,648 |
9,271 |
$454K |
| D1110 |
Prophylaxis - adult |
6,240 |
5,287 |
$272K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,714 |
1,002 |
$152K |
| D0274 |
Bitewings - four radiographic images |
4,133 |
3,737 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
7,385 |
7,340 |
$72K |
| D1120 |
Prophylaxis - child |
1,993 |
1,795 |
$60K |
| 90834 |
Psychotherapy, 45 minutes with patient |
695 |
301 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,490 |
6,258 |
$41K |
| 99442 |
|
336 |
261 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,065 |
557 |
$38K |
| 99441 |
|
291 |
225 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
717 |
476 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,074 |
735 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,494 |
2,441 |
$28K |
| D1351 |
Sealant - per tooth |
389 |
329 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
338 |
234 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
89 |
$11K |
| D0272 |
Bitewings - two radiographic images |
861 |
861 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
94 |
68 |
$9K |
| 3008F |
|
113 |
48 |
$5K |
| D1206 |
Topical application of fluoride varnish |
174 |
149 |
$4K |
| 90832 |
Psychotherapy, 30 minutes with patient |
16 |
12 |
$3K |
| D1330 |
|
634 |
610 |
$2K |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
60 |
60 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
13 |
$255.73 |
| D0602 |
|
453 |
453 |
$0.00 |
| D0601 |
|
725 |
725 |
$0.00 |
| D1310 |
|
506 |
495 |
$0.00 |
| D0603 |
|
181 |
181 |
$0.00 |