| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
3,230 |
2,574 |
$1.08M |
| 99384 |
|
682 |
671 |
$437K |
| 99383 |
|
775 |
688 |
$409K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
871 |
748 |
$307K |
| 99382 |
|
390 |
370 |
$177K |
| 90837 |
Psychotherapy, 53 minutes with patient |
166 |
110 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
167 |
146 |
$43K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
131 |
115 |
$40K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
90 |
67 |
$23K |
| 99173 |
|
1,913 |
1,881 |
$16K |
| D1206 |
Topical application of fluoride varnish |
195 |
182 |
$15K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
42 |
31 |
$12K |
| 85018 |
|
134 |
121 |
$5K |
| D1120 |
Prophylaxis - child |
30 |
30 |
$3K |
| D1351 |
Sealant - per tooth |
91 |
25 |
$2K |
| D0274 |
Bitewings - four radiographic images |
15 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
85 |
71 |
$0.00 |
| 92551 |
|
1,753 |
1,724 |
$0.00 |