| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,660 |
1,526 |
$303K |
| D0999 |
Unspecified diagnostic procedure, by report |
900 |
769 |
$116K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
660 |
617 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
254 |
240 |
$3K |
| D1110 |
Prophylaxis - adult |
66 |
64 |
$485.95 |
| D0274 |
Bitewings - four radiographic images |
101 |
90 |
$419.50 |
| D1206 |
Topical application of fluoride varnish |
314 |
290 |
$410.76 |
| D0330 |
Panoramic radiographic image |
45 |
44 |
$300.20 |
| D0120 |
Periodic oral evaluation - established patient |
165 |
153 |
$233.91 |
| 87428 |
|
13 |
13 |
$92.82 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
20 |
20 |
$84.14 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
15 |
15 |
$41.67 |
| 1000F |
|
231 |
202 |
$0.00 |
| D0603 |
|
88 |
80 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
13 |
$0.00 |
| 1125F |
|
13 |
12 |
$0.00 |
| 2001F |
|
225 |
197 |
$0.00 |
| 4000F |
|
102 |
93 |
$0.00 |
| 3008F |
|
226 |
198 |
$0.00 |
| 2000F |
|
227 |
199 |
$0.00 |
| 1220F |
|
201 |
177 |
$0.00 |
| D0601 |
|
15 |
13 |
$0.00 |
| 1126F |
|
16 |
14 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
160 |
149 |
$0.00 |
| 3074F |
|
63 |
53 |
$0.00 |
| D1330 |
|
34 |
32 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |
| 1160F |
|
144 |
125 |
$0.00 |
| D1120 |
Prophylaxis - child |
28 |
27 |
$0.00 |
| 1159F |
|
144 |
125 |
$0.00 |
| D0431 |
|
133 |
118 |
$0.00 |
| 3078F |
|
16 |
13 |
$0.00 |
| 81025 |
|
12 |
12 |
$0.00 |