| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0486 |
Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment |
126 |
123 |
$200K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,762 |
1,657 |
$96K |
| D1110 |
Prophylaxis - adult |
761 |
759 |
$34K |
| 21110 |
|
55 |
55 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
450 |
449 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
270 |
270 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
502 |
494 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
287 |
286 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
95 |
95 |
$2K |
| D1320 |
|
272 |
272 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
46 |
45 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
14 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
13 |
$916.44 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$227.85 |
| D9910 |
|
179 |
179 |
$0.00 |
| D1999 |
|
177 |
177 |
$0.00 |
| D1330 |
|
154 |
154 |
$0.00 |