| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
727 |
236 |
$11K |
| T1016 |
Case management, each 15 minutes |
262 |
153 |
$8K |
| D1206 |
Topical application of fluoride varnish |
484 |
477 |
$6K |
| D0999 |
Unspecified diagnostic procedure, by report |
560 |
551 |
$6K |
| 99188 |
|
520 |
457 |
$4K |
| 83655 |
|
416 |
365 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
278 |
253 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
167 |
153 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
181 |
151 |
$1K |
| 36416 |
|
340 |
305 |
$583.85 |
| 90688 |
|
20 |
20 |
$280.54 |
| 85018 |
|
15 |
15 |
$25.77 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
22 |
20 |
$0.00 |