| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,760 |
1,186 |
$48K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,053 |
7,932 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
585 |
268 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,118 |
846 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,126 |
757 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
1,036 |
605 |
$15K |
| 99442 |
|
1,984 |
1,558 |
$15K |
| 97802 |
|
861 |
635 |
$13K |
| D0330 |
Panoramic radiographic image |
389 |
329 |
$11K |
| D2140 |
|
224 |
121 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
536 |
341 |
$7K |
| 97803 |
|
592 |
436 |
$7K |
| D1120 |
Prophylaxis - child |
337 |
217 |
$6K |
| D2330 |
|
84 |
25 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,109 |
1,707 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
119 |
86 |
$2K |
| D2160 |
|
31 |
14 |
$2K |
| 99215 |
Prolong outpt/office vis |
354 |
295 |
$2K |
| 99441 |
|
1,631 |
1,367 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
238 |
164 |
$2K |
| 96160 |
|
709 |
492 |
$2K |
| D2331 |
|
25 |
15 |
$1K |
| 96127 |
|
2,973 |
2,453 |
$591.06 |
| D1999 |
|
20 |
17 |
$290.20 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
171 |
148 |
$76.80 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
20 |
20 |
$59.46 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
830 |
661 |
$50.15 |
| 93000 |
|
107 |
106 |
$48.00 |
| 3078F |
|
3,161 |
2,845 |
$0.00 |
| 1159F |
|
6,742 |
5,544 |
$0.00 |
| 1100F |
|
840 |
781 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
781 |
674 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
2,582 |
2,172 |
$0.00 |
| 1160F |
|
6,686 |
5,495 |
$0.00 |
| 99408 |
|
317 |
207 |
$0.00 |
| 3077F |
|
118 |
110 |
$0.00 |
| 1158F |
|
546 |
530 |
$0.00 |
| 3050F |
|
12 |
12 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
483 |
370 |
$0.00 |
| 2028F |
|
135 |
128 |
$0.00 |
| 3725F |
|
810 |
582 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
103 |
90 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
78 |
65 |
$0.00 |
| G2012 |
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
28 |
28 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
16 |
14 |
$0.00 |
| 2000F |
|
231 |
210 |
$0.00 |
| 3079F |
|
2,349 |
2,114 |
$0.00 |
| 1126F |
|
6,117 |
4,941 |
$0.00 |
| 3008F |
|
2,907 |
2,531 |
$0.00 |
| 1125F |
|
1,143 |
1,071 |
$0.00 |
| 3075F |
|
1,362 |
1,238 |
$0.00 |
| 1036F |
|
2,243 |
2,029 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
3,086 |
2,525 |
$0.00 |
| D0603 |
|
652 |
425 |
$0.00 |
| 3074F |
|
4,004 |
3,544 |
$0.00 |
| D1310 |
|
1,891 |
1,185 |
$0.00 |
| D1330 |
|
1,906 |
1,191 |
$0.00 |
| 1000F |
|
1,491 |
1,322 |
$0.00 |
| D0602 |
|
1,016 |
609 |
$0.00 |
| 3048F |
|
188 |
163 |
$0.00 |
| 4000F |
|
312 |
220 |
$0.00 |
| 99443 |
|
88 |
62 |
$0.00 |
| 1136F |
|
26 |
26 |
$0.00 |
| 1005F |
|
45 |
39 |
$0.00 |
| 3049F |
|
14 |
12 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |
| 3011F |
|
15 |
15 |
$0.00 |