| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,230 |
1,075 |
$70K |
| 90832 |
Psychotherapy, 30 minutes with patient |
308 |
140 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
174 |
140 |
$14K |
| 90834 |
Psychotherapy, 45 minutes with patient |
189 |
105 |
$12K |
| D0330 |
Panoramic radiographic image |
279 |
270 |
$9K |
| 90837 |
Psychotherapy, 53 minutes with patient |
70 |
42 |
$6K |
| D1110 |
Prophylaxis - adult |
121 |
115 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
237 |
229 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
353 |
328 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
19 |
19 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
76 |
64 |
$2K |
| D1206 |
Topical application of fluoride varnish |
136 |
120 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
25 |
$1K |
| D1351 |
Sealant - per tooth |
36 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
30 |
30 |
$921.62 |
| 99383 |
|
12 |
12 |
$921.52 |
| D0220 |
Intraoral - periapical first radiographic image |
704 |
664 |
$882.94 |
| D0274 |
Bitewings - four radiographic images |
217 |
212 |
$629.78 |
| 99406 |
|
49 |
46 |
$467.76 |
| D0230 |
Intraoral - periapical each additional radiographic image |
397 |
375 |
$429.00 |
| D0120 |
Periodic oral evaluation - established patient |
17 |
17 |
$416.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$394.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
16 |
14 |
$240.00 |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$234.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
13 |
12 |
$106.50 |
| 81003 |
|
50 |
49 |
$99.17 |
| D0603 |
|
244 |
234 |
$98.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
18 |
17 |
$86.50 |
| D1330 |
|
171 |
157 |
$57.01 |
| 85018 |
|
54 |
53 |
$53.55 |
| D3120 |
|
14 |
12 |
$16.00 |
| 97802 |
|
15 |
15 |
$0.12 |
| 3074F |
|
515 |
472 |
$0.00 |
| 1125F |
|
259 |
227 |
$0.00 |
| 92551 |
|
79 |
79 |
$0.00 |
| 1000F |
|
602 |
553 |
$0.00 |
| 3079F |
|
135 |
124 |
$0.00 |
| 3008F |
|
537 |
505 |
$0.00 |
| 1036F |
|
360 |
335 |
$0.00 |
| 1126F |
|
163 |
157 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
80 |
79 |
$0.00 |
| S9451 |
Exercise classes, non-physician provider, per session |
43 |
43 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
14 |
12 |
$0.00 |
| 1159F |
|
1,635 |
1,395 |
$0.00 |
| 1160F |
|
1,635 |
1,395 |
$0.00 |
| 3078F |
|
406 |
380 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
270 |
240 |
$0.00 |
| 99173 |
|
108 |
101 |
$0.00 |