| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0451 |
Development testing, with interpretation and report, per standardized instrument form |
3,226 |
3,138 |
$191K |
| D0190 |
|
13,327 |
13,005 |
$180K |
| D1351 |
Sealant - per tooth |
3,504 |
1,730 |
$151K |
| D1206 |
Topical application of fluoride varnish |
12,454 |
12,181 |
$149K |
| D1330 |
|
8,470 |
8,288 |
$115K |
| 99174 |
|
2,205 |
2,067 |
$25K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
164 |
149 |
$11K |
| D0602 |
|
11,674 |
11,391 |
$7K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
274 |
253 |
$6K |
| 83655 |
|
369 |
353 |
$5K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
329 |
314 |
$5K |
| H0046 |
Mental health services, not otherwise specified |
112 |
98 |
$4K |
| D0603 |
|
1,569 |
1,535 |
$943.85 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
175 |
156 |
$695.39 |
| 96160 |
|
119 |
78 |
$450.45 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
13 |
13 |
$152.90 |
| 96161 |
|
13 |
13 |
$16.38 |
| 90658 |
|
93 |
91 |
$0.00 |
| 90734 |
|
16 |
14 |
$0.00 |
| 90686 |
|
181 |
168 |
$0.00 |
| 90688 |
|
137 |
118 |
$0.00 |