| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,478 |
1,035 |
$559K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
323 |
282 |
$190K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
137 |
92 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
169 |
138 |
$58K |
| 0012A |
|
42 |
40 |
$31K |
| D1206 |
Topical application of fluoride varnish |
297 |
235 |
$23K |
| D1120 |
Prophylaxis - child |
216 |
177 |
$16K |
| 0011A |
|
27 |
25 |
$13K |
| D0274 |
Bitewings - four radiographic images |
109 |
88 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
14 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
13 |
$2K |
| 99000 |
|
18 |
17 |
$0.00 |
| 99070 |
|
112 |
74 |
$0.00 |
| D0240 |
|
49 |
22 |
$0.00 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
394 |
280 |
$0.00 |
| D1203 |
|
17 |
17 |
$0.00 |
| D1354 |
|
481 |
71 |
$0.00 |