| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
6,260 |
6,087 |
$219K |
| 99402 |
|
1,018 |
940 |
$50K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
762 |
742 |
$48K |
| 99381 |
|
563 |
548 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,167 |
1,166 |
$22K |
| 99401 |
|
717 |
650 |
$21K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,700 |
1,639 |
$16K |
| 90651 |
|
583 |
561 |
$12K |
| 81025 |
|
2,149 |
1,919 |
$11K |
| D0190 |
|
773 |
770 |
$9K |
| D1120 |
Prophylaxis - child |
175 |
175 |
$6K |
| 0001A |
|
123 |
97 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
134 |
$4K |
| 90715 |
|
721 |
700 |
$3K |
| 90716 |
|
486 |
470 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
181 |
164 |
$3K |
| 90734 |
|
394 |
388 |
$3K |
| 90707 |
|
487 |
470 |
$2K |
| D1110 |
Prophylaxis - adult |
69 |
68 |
$2K |
| 0002A |
|
54 |
43 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
75 |
75 |
$2K |
| 96127 |
|
380 |
356 |
$2K |
| 92551 |
|
131 |
122 |
$924.98 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
33 |
28 |
$864.83 |
| D0272 |
Bitewings - two radiographic images |
47 |
47 |
$796.79 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
42 |
42 |
$722.15 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
89 |
81 |
$707.37 |
| 90688 |
|
179 |
174 |
$635.00 |
| 99173 |
|
153 |
147 |
$477.33 |
| 90686 |
|
1,876 |
1,847 |
$425.00 |
| 36415 |
Collection of venous blood by venipuncture |
219 |
202 |
$423.65 |
| 90461 |
|
2,794 |
2,697 |
$360.32 |
| 90619 |
|
72 |
68 |
$258.86 |
| 90656 |
|
18 |
14 |
$196.85 |
| 90633 |
|
561 |
545 |
$123.93 |
| 90744 |
|
105 |
103 |
$22.02 |
| 36416 |
|
13 |
12 |
$20.10 |
| 90698 |
|
194 |
184 |
$0.00 |
| 90674 |
|
270 |
269 |
$0.00 |
| 90697 |
|
33 |
30 |
$0.00 |
| 90696 |
|
128 |
124 |
$0.00 |
| 90680 |
|
29 |
25 |
$0.00 |
| 90670 |
|
479 |
465 |
$0.00 |
| 90710 |
|
45 |
44 |
$0.00 |
| 90671 |
|
66 |
63 |
$0.00 |
| 90661 |
|
279 |
278 |
$0.00 |
| 91300 |
|
33 |
30 |
$0.00 |