| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,457 |
2,425 |
$355K |
| D0999 |
Unspecified diagnostic procedure, by report |
2,134 |
1,010 |
$159K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,396 |
1,038 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
59 |
29 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
822 |
499 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
57 |
28 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,401 |
388 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,339 |
935 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
115 |
57 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
47 |
29 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,072 |
503 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
103 |
79 |
$0.00 |
| D1110 |
Prophylaxis - adult |
57 |
28 |
$0.00 |