| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
27,327 |
20,925 |
$919K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
5,832 |
4,656 |
$136K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
10,835 |
8,602 |
$119K |
| D1110 |
Prophylaxis - adult |
2,627 |
2,576 |
$111K |
| D1206 |
Topical application of fluoride varnish |
5,300 |
5,199 |
$109K |
| D1120 |
Prophylaxis - child |
3,384 |
3,325 |
$103K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,895 |
1,472 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
3,785 |
3,718 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,378 |
1,344 |
$78K |
| 99381 |
|
1,335 |
1,059 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,191 |
2,154 |
$62K |
| 90716 |
|
9,262 |
7,075 |
$55K |
| 99382 |
|
787 |
614 |
$45K |
| 99383 |
|
778 |
602 |
$44K |
| D1354 |
|
7,397 |
1,547 |
$41K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
784 |
606 |
$36K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,940 |
1,429 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,641 |
1,619 |
$35K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
858 |
626 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,713 |
2,670 |
$34K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
2,959 |
2,218 |
$32K |
| 83655 |
|
3,677 |
2,800 |
$32K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
593 |
417 |
$30K |
| D1351 |
Sealant - per tooth |
1,318 |
301 |
$28K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
619 |
494 |
$28K |
| 99401 |
|
1,511 |
1,146 |
$26K |
| 99384 |
|
430 |
327 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,664 |
2,434 |
$25K |
| 90715 |
|
7,560 |
5,788 |
$23K |
| 81025 |
|
5,898 |
4,494 |
$23K |
| 92551 |
|
3,671 |
2,791 |
$20K |
| 99173 |
|
5,125 |
3,922 |
$20K |
| 90707 |
|
8,585 |
6,526 |
$16K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
225 |
173 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
633 |
627 |
$12K |
| 85018 |
|
6,355 |
4,879 |
$12K |
| 90651 |
|
3,255 |
2,435 |
$11K |
| 90734 |
|
3,342 |
2,418 |
$10K |
| 86580 |
|
2,585 |
2,006 |
$10K |
| 96127 |
|
3,442 |
2,535 |
$10K |
| D0272 |
Bitewings - two radiographic images |
536 |
528 |
$9K |
| 90746 |
|
123 |
99 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
43 |
$4K |
| 94250 |
|
226 |
158 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
418 |
324 |
$3K |
| 99385 |
|
43 |
28 |
$2K |
| 81002 |
|
1,001 |
731 |
$2K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
47 |
42 |
$2K |
| 90713 |
|
1,959 |
1,513 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
17 |
$1K |
| 90670 |
|
5,983 |
4,763 |
$1K |
| 90688 |
|
297 |
201 |
$1K |
| D1353 |
|
173 |
41 |
$976.00 |
| 90480 |
|
72 |
51 |
$855.09 |
| 36415 |
Collection of venous blood by venipuncture |
572 |
438 |
$829.80 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
45 |
16 |
$683.60 |
| 90619 |
|
372 |
317 |
$650.00 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$581.20 |
| 90677 |
|
400 |
335 |
$376.22 |
| 99411 |
|
42 |
36 |
$368.04 |
| 71046 |
Radiologic examination, chest; 2 views |
21 |
15 |
$330.31 |
| 99071 |
|
113 |
81 |
$250.00 |
| 90696 |
|
3,927 |
2,962 |
$220.29 |
| 90632 |
|
29 |
27 |
$180.00 |
| 90633 |
|
8,504 |
6,709 |
$137.79 |
| 90723 |
|
3,796 |
3,041 |
$130.00 |
| 90647 |
|
2,795 |
2,215 |
$102.28 |
| 90710 |
|
1,508 |
1,295 |
$79.22 |
| 90744 |
|
1,236 |
945 |
$58.35 |
| 87797 |
|
2,152 |
1,636 |
$52.96 |
| 90658 |
|
25 |
14 |
$40.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
1,794 |
1,577 |
$32.99 |
| 90700 |
|
2,831 |
2,239 |
$25.00 |
| 90714 |
|
40 |
31 |
$24.26 |
| 90697 |
|
500 |
402 |
$20.00 |
| 90671 |
|
77 |
53 |
$20.00 |
| 90648 |
|
924 |
701 |
$17.37 |
| 90461 |
|
10,248 |
8,112 |
$11.26 |
| 99000 |
|
2,519 |
1,943 |
$6.00 |
| 86592 |
|
1,767 |
1,558 |
$5.13 |
| A4268 |
Contraceptive supply, condom, female, each |
650 |
506 |
$1.89 |
| 87210 |
|
204 |
183 |
$1.64 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
712 |
580 |
$0.00 |
| 90680 |
|
995 |
769 |
$0.00 |
| 88271 |
|
116 |
100 |
$0.00 |
| G0472 |
Hepatitis c antibody screening, for individual at high risk and other covered indication(s) |
1,040 |
925 |
$0.00 |
| 90698 |
|
1,211 |
936 |
$0.00 |
| 90686 |
|
989 |
717 |
$0.00 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
189 |
144 |
$0.00 |
| 90620 |
|
33 |
25 |
$0.00 |
| 88166 |
|
19 |
16 |
$0.00 |
| D1330 |
|
21 |
21 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
716 |
580 |
$0.00 |
| 90681 |
|
49 |
43 |
$0.00 |
| A4267 |
Contraceptive supply, condom, male, each |
57 |
52 |
$0.00 |