| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,377 |
2,301 |
$128K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,235 |
2,051 |
$61K |
| 99401 |
|
1,013 |
964 |
$25K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
695 |
639 |
$23K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,070 |
985 |
$18K |
| 90686 |
|
1,012 |
974 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
325 |
299 |
$7K |
| 90651 |
|
277 |
253 |
$7K |
| 91320 |
|
49 |
39 |
$3K |
| 90715 |
|
353 |
334 |
$2K |
| 90734 |
|
493 |
470 |
$1K |
| 90480 |
|
74 |
60 |
$944.82 |
| 90746 |
|
12 |
12 |
$836.88 |
| 90688 |
|
80 |
79 |
$800.30 |
| 90716 |
|
14 |
14 |
$681.56 |
| 99201 |
|
17 |
17 |
$415.22 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
16 |
13 |
$226.29 |
| 36416 |
|
107 |
101 |
$158.63 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
15 |
12 |
$128.88 |
| 86580 |
|
15 |
14 |
$88.87 |
| 86703 |
|
12 |
12 |
$82.24 |
| G0008 |
Administration of influenza virus vaccine |
14 |
12 |
$61.57 |
| 36415 |
Collection of venous blood by venipuncture |
24 |
24 |
$49.71 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
73 |
66 |
$0.00 |
| 83655 |
|
93 |
87 |
$0.00 |
| 90633 |
|
35 |
29 |
$0.00 |
| 99001 |
|
14 |
14 |
$0.00 |
| 99000 |
|
205 |
188 |
$0.00 |
| 90620 |
|
25 |
25 |
$0.00 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
41 |
38 |
$0.00 |
| 85018 |
|
93 |
87 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
73 |
66 |
$0.00 |