| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,777 |
2,622 |
$226K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,490 |
2,339 |
$140K |
| 90837 |
Psychotherapy, 53 minutes with patient |
192 |
128 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,770 |
1,318 |
$29K |
| D1110 |
Prophylaxis - adult |
775 |
763 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
74 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
720 |
709 |
$9K |
| 90686 |
|
429 |
386 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
910 |
637 |
$7K |
| D4910 |
|
115 |
115 |
$4K |
| 0002A |
|
87 |
87 |
$3K |
| 0001A |
|
119 |
118 |
$2K |
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
45 |
42 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
80 |
$2K |
| D0274 |
Bitewings - four radiographic images |
145 |
138 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
336 |
98 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
134 |
111 |
$2K |
| 0124A |
|
57 |
52 |
$2K |
| 0004A |
|
41 |
41 |
$2K |
| D1206 |
Topical application of fluoride varnish |
142 |
136 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
384 |
354 |
$1K |
| 96127 |
|
354 |
313 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
12 |
$1K |
| 0003A |
|
27 |
27 |
$1K |
| D1120 |
Prophylaxis - child |
16 |
14 |
$479.38 |
| 91312 |
|
34 |
32 |
$132.19 |