| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,595 |
3,459 |
$154K |
| D1206 |
Topical application of fluoride varnish |
3,139 |
3,131 |
$64K |
| D1110 |
Prophylaxis - adult |
1,237 |
1,235 |
$53K |
| 99402 |
|
1,030 |
957 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,045 |
2,041 |
$50K |
| D1351 |
Sealant - per tooth |
4,765 |
671 |
$46K |
| D1120 |
Prophylaxis - child |
1,289 |
1,285 |
$43K |
| 99384 |
|
289 |
281 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,642 |
1,637 |
$29K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
363 |
345 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
958 |
954 |
$28K |
| 90651 |
|
858 |
816 |
$26K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,482 |
1,368 |
$23K |
| 99401 |
|
738 |
673 |
$21K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
230 |
218 |
$20K |
| D0330 |
Panoramic radiographic image |
537 |
537 |
$20K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
253 |
247 |
$16K |
| 81025 |
|
3,098 |
2,781 |
$16K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
543 |
488 |
$14K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,146 |
1,090 |
$13K |
| 99381 |
|
139 |
133 |
$11K |
| 92551 |
|
824 |
785 |
$6K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
112 |
109 |
$5K |
| 96127 |
|
1,134 |
1,062 |
$5K |
| D0190 |
|
384 |
383 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
40 |
$4K |
| 99173 |
|
1,017 |
971 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
335 |
290 |
$3K |
| 90734 |
|
506 |
485 |
$3K |
| 90716 |
|
365 |
360 |
$2K |
| D0274 |
Bitewings - four radiographic images |
90 |
90 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
1,015 |
935 |
$2K |
| 90707 |
|
396 |
385 |
$2K |
| 90715 |
|
502 |
481 |
$2K |
| 90688 |
|
246 |
225 |
$2K |
| 0002A |
|
35 |
26 |
$1K |
| 0001A |
|
33 |
25 |
$1K |
| 85018 |
|
260 |
247 |
$796.31 |
| 36416 |
|
280 |
264 |
$793.26 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
13 |
$520.72 |
| 90619 |
|
67 |
62 |
$517.72 |
| 90671 |
|
12 |
12 |
$404.06 |
| 90461 |
|
2,119 |
2,038 |
$394.10 |
| 99201 |
|
16 |
13 |
$341.36 |
| 90686 |
|
375 |
363 |
$145.00 |
| 90696 |
|
118 |
116 |
$134.63 |
| 90633 |
|
428 |
415 |
$88.89 |
| 90670 |
|
143 |
131 |
$0.00 |
| 90685 |
|
27 |
26 |
$0.00 |
| 91300 |
|
15 |
15 |
$0.00 |
| D1330 |
|
75 |
75 |
$0.00 |
| 90698 |
|
74 |
69 |
$0.00 |
| 90677 |
|
25 |
25 |
$0.00 |
| 90744 |
|
27 |
26 |
$0.00 |
| 99000 |
|
25 |
25 |
$0.00 |