| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,602 |
3,486 |
$154K |
| D1120 |
Prophylaxis - child |
890 |
874 |
$27K |
| 99381 |
|
291 |
270 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,109 |
1,086 |
$20K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
263 |
260 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
697 |
682 |
$16K |
| 99402 |
|
228 |
213 |
$11K |
| D0272 |
Bitewings - two radiographic images |
675 |
663 |
$11K |
| 99401 |
|
371 |
335 |
$11K |
| 90651 |
|
388 |
367 |
$10K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
985 |
939 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
249 |
246 |
$7K |
| 81025 |
|
1,186 |
1,050 |
$6K |
| D1206 |
Topical application of fluoride varnish |
302 |
302 |
$6K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
367 |
320 |
$6K |
| D0190 |
|
302 |
302 |
$3K |
| 90716 |
|
251 |
243 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
25 |
25 |
$2K |
| D1110 |
Prophylaxis - adult |
41 |
41 |
$2K |
| 90707 |
|
311 |
304 |
$2K |
| 90715 |
|
415 |
401 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
30 |
28 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
156 |
145 |
$1K |
| 96127 |
|
278 |
259 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
320 |
282 |
$563.53 |
| 90734 |
|
172 |
167 |
$431.64 |
| 90688 |
|
74 |
72 |
$400.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
16 |
12 |
$362.09 |
| 90686 |
|
572 |
559 |
$320.00 |
| 92551 |
|
29 |
24 |
$193.40 |
| 99173 |
|
60 |
56 |
$177.41 |
| 90670 |
|
525 |
509 |
$160.66 |
| 90619 |
|
97 |
94 |
$129.43 |
| 90461 |
|
2,356 |
2,291 |
$123.86 |
| 90698 |
|
14 |
13 |
$82.64 |
| 90633 |
|
440 |
426 |
$76.78 |
| 90648 |
|
67 |
63 |
$0.00 |
| 90671 |
|
79 |
71 |
$0.00 |
| 90710 |
|
79 |
78 |
$0.00 |
| 90696 |
|
28 |
28 |
$0.00 |
| 90697 |
|
14 |
14 |
$0.00 |