| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,103 |
2,869 |
$125K |
| 99401 |
|
1,020 |
886 |
$27K |
| D1206 |
Topical application of fluoride varnish |
613 |
613 |
$12K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
715 |
618 |
$10K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
89 |
81 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
151 |
148 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
71 |
62 |
$5K |
| 81025 |
|
1,051 |
926 |
$5K |
| D1120 |
Prophylaxis - child |
131 |
131 |
$4K |
| 90651 |
|
450 |
410 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
138 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
158 |
129 |
$3K |
| 92551 |
|
260 |
237 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
192 |
177 |
$2K |
| D0190 |
|
159 |
159 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
156 |
136 |
$2K |
| D1110 |
Prophylaxis - adult |
41 |
41 |
$2K |
| 90734 |
|
326 |
289 |
$2K |
| 96127 |
|
347 |
317 |
$1K |
| 0001A |
|
40 |
34 |
$1K |
| 90688 |
|
784 |
759 |
$1K |
| 90715 |
|
565 |
513 |
$1K |
| 90716 |
|
152 |
143 |
$1K |
| D0274 |
Bitewings - four radiographic images |
47 |
47 |
$963.96 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
81 |
76 |
$764.48 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$634.15 |
| 99173 |
|
199 |
190 |
$575.65 |
| 0002A |
|
22 |
17 |
$560.00 |
| 90707 |
|
151 |
143 |
$448.21 |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$443.17 |
| 99177 |
|
102 |
79 |
$428.68 |
| 36415 |
Collection of venous blood by venipuncture |
247 |
209 |
$413.94 |
| 90686 |
|
61 |
57 |
$270.00 |
| 90619 |
|
53 |
53 |
$258.86 |
| 83655 |
|
19 |
16 |
$227.19 |
| 90670 |
|
344 |
305 |
$160.66 |
| 90461 |
|
1,105 |
1,003 |
$112.60 |
| 90656 |
|
12 |
12 |
$97.06 |
| 90696 |
|
105 |
99 |
$94.34 |
| 90633 |
|
237 |
219 |
$59.26 |
| 36416 |
|
24 |
20 |
$36.85 |
| 90648 |
|
365 |
328 |
$19.83 |
| 90723 |
|
232 |
205 |
$0.00 |
| 90680 |
|
82 |
69 |
$0.00 |
| 90710 |
|
113 |
108 |
$0.00 |
| 90700 |
|
41 |
37 |
$0.00 |