| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,486 |
5,090 |
$267K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,825 |
1,643 |
$70K |
| 99402 |
|
1,010 |
866 |
$48K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,012 |
2,599 |
$45K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
1,048 |
924 |
$40K |
| 99401 |
|
1,468 |
1,273 |
$39K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
554 |
514 |
$39K |
| 99381 |
|
444 |
427 |
$34K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,431 |
1,215 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,202 |
1,199 |
$22K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,001 |
1,863 |
$18K |
| 81025 |
|
3,754 |
3,217 |
$17K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
187 |
170 |
$12K |
| D0190 |
|
1,004 |
1,001 |
$11K |
| 92551 |
|
1,412 |
1,281 |
$10K |
| 99384 |
|
87 |
82 |
$8K |
| 36415 |
Collection of venous blood by venipuncture |
4,130 |
3,580 |
$7K |
| 99383 |
|
74 |
72 |
$7K |
| 90651 |
|
821 |
780 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
84 |
80 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
65 |
64 |
$6K |
| 96127 |
|
1,447 |
1,305 |
$6K |
| 99173 |
|
1,590 |
1,449 |
$5K |
| 90716 |
|
858 |
808 |
$4K |
| D1120 |
Prophylaxis - child |
128 |
128 |
$4K |
| 85018 |
|
1,266 |
1,143 |
$3K |
| 36416 |
|
1,382 |
1,244 |
$3K |
| 90707 |
|
840 |
790 |
$2K |
| 90734 |
|
547 |
516 |
$2K |
| 83655 |
|
167 |
133 |
$2K |
| 0001A |
|
55 |
38 |
$2K |
| 90715 |
|
1,010 |
952 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
18 |
16 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
54 |
54 |
$1K |
| 0002A |
|
42 |
33 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
31 |
28 |
$1K |
| 99382 |
|
12 |
12 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
145 |
118 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
60 |
$1K |
| 99403 |
|
13 |
12 |
$950.70 |
| D0274 |
Bitewings - four radiographic images |
43 |
43 |
$904.96 |
| 90670 |
|
1,039 |
971 |
$803.30 |
| 90688 |
|
374 |
340 |
$800.00 |
| 90686 |
|
320 |
292 |
$675.00 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$444.72 |
| 99442 |
|
22 |
13 |
$362.73 |
| 99201 |
|
15 |
13 |
$333.69 |
| 87210 |
|
82 |
70 |
$306.28 |
| 94250 |
|
14 |
12 |
$264.44 |
| 90633 |
|
1,458 |
1,366 |
$254.56 |
| 90696 |
|
390 |
362 |
$235.85 |
| 90461 |
|
2,554 |
2,384 |
$112.60 |
| 90680 |
|
106 |
93 |
$77.60 |
| 90656 |
|
38 |
38 |
$72.27 |
| 90723 |
|
554 |
527 |
$71.48 |
| 90648 |
|
958 |
900 |
$59.49 |
| 90700 |
|
425 |
395 |
$44.76 |
| 90697 |
|
27 |
27 |
$0.00 |
| 90619 |
|
62 |
62 |
$0.00 |
| 99000 |
|
30 |
27 |
$0.00 |
| 90674 |
|
27 |
26 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
34 |
33 |
$0.00 |
| 90671 |
|
18 |
18 |
$0.00 |
| 90713 |
|
208 |
192 |
$0.00 |
| 90710 |
|
379 |
351 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
27 |
$0.00 |