| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
821 |
737 |
$27K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
475 |
412 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
68 |
61 |
$4K |
| D1206 |
Topical application of fluoride varnish |
170 |
168 |
$3K |
| 99401 |
|
112 |
91 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
35 |
29 |
$2K |
| D0330 |
Panoramic radiographic image |
50 |
46 |
$2K |
| D0190 |
|
151 |
149 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
52 |
$658.80 |
| 90686 |
|
296 |
270 |
$445.30 |
| 90651 |
|
18 |
17 |
$369.70 |
| 90734 |
|
33 |
31 |
$323.73 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
21 |
18 |
$188.87 |
| 83655 |
|
15 |
12 |
$179.43 |
| 85018 |
|
33 |
27 |
$78.09 |
| 36416 |
|
34 |
27 |
$67.00 |
| 81025 |
|
12 |
12 |
$61.00 |
| 90461 |
|
298 |
267 |
$0.00 |
| 90715 |
|
34 |
31 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |