| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 97802 |
|
2,789 |
2,787 |
$88K |
| 92081 |
|
2,109 |
2,105 |
$70K |
| D1206 |
Topical application of fluoride varnish |
1,261 |
1,242 |
$30K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,739 |
2,612 |
$20K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
254 |
253 |
$17K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
218 |
212 |
$7K |
| 81002 |
|
2,418 |
2,415 |
$5K |
| 90697 |
|
108 |
108 |
$3K |
| 90680 |
|
589 |
583 |
$1K |
| 90670 |
|
1,010 |
1,001 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
945 |
943 |
$1K |
| 90698 |
|
603 |
597 |
$825.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
400 |
399 |
$740.99 |
| 99460 |
|
12 |
12 |
$719.96 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
320 |
320 |
$702.52 |
| 90744 |
|
313 |
308 |
$522.00 |
| 92552 |
|
1,430 |
1,428 |
$450.40 |
| 97803 |
|
14 |
13 |
$438.62 |
| 90686 |
|
1,574 |
1,572 |
$305.37 |
| 81000 |
|
136 |
136 |
$301.86 |
| 90633 |
|
548 |
540 |
$81.00 |
| 90734 |
|
365 |
364 |
$54.00 |
| 90672 |
|
157 |
157 |
$36.00 |
| 90710 |
|
169 |
169 |
$27.00 |
| 90696 |
|
80 |
80 |
$18.00 |
| 90649 |
|
362 |
362 |
$18.00 |
| 90716 |
|
105 |
102 |
$9.00 |
| 90647 |
|
80 |
79 |
$9.00 |
| 90715 |
|
85 |
85 |
$9.00 |
| 90700 |
|
68 |
67 |
$9.00 |
| 90707 |
|
105 |
102 |
$9.00 |
| 85018 |
|
326 |
326 |
$4.96 |
| 90688 |
|
92 |
92 |
$0.00 |
| 90621 |
|
70 |
70 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
290 |
289 |
$0.00 |
| 90461 |
|
16 |
16 |
$0.00 |
| 90685 |
|
52 |
52 |
$0.00 |