| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99401 |
|
881 |
788 |
$24K |
| 99381 |
|
272 |
262 |
$22K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
485 |
452 |
$20K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
696 |
666 |
$7K |
| D1206 |
Topical application of fluoride varnish |
333 |
333 |
$6K |
| D0330 |
Panoramic radiographic image |
246 |
237 |
$5K |
| 81025 |
|
1,014 |
878 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
430 |
377 |
$4K |
| D0190 |
|
332 |
332 |
$4K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
41 |
41 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
13 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
133 |
120 |
$2K |
| 90651 |
|
19 |
15 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
13 |
$349.34 |
| 96127 |
|
41 |
40 |
$168.75 |
| 36415 |
Collection of venous blood by venipuncture |
15 |
14 |
$33.37 |
| 90686 |
|
30 |
30 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| 90461 |
|
146 |
138 |
$0.00 |