| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,730 |
2,562 |
$89K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,116 |
1,747 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,655 |
1,610 |
$30K |
| 99401 |
|
1,220 |
932 |
$29K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
204 |
188 |
$14K |
| D0190 |
|
1,211 |
1,166 |
$12K |
| D1120 |
Prophylaxis - child |
302 |
295 |
$9K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
907 |
797 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
129 |
118 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
308 |
308 |
$7K |
| D0330 |
Panoramic radiographic image |
187 |
151 |
$5K |
| 99381 |
|
39 |
26 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
281 |
234 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
81 |
$2K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
73 |
65 |
$2K |
| 90688 |
|
1,176 |
1,123 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
94 |
90 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
52 |
49 |
$1K |
| 81025 |
|
301 |
236 |
$1K |
| 96127 |
|
294 |
245 |
$1K |
| 0011A |
|
55 |
38 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
802 |
676 |
$945.02 |
| D0140 |
Limited oral evaluation - problem focused |
46 |
37 |
$902.80 |
| 90715 |
|
274 |
258 |
$852.69 |
| 92551 |
|
113 |
101 |
$843.29 |
| 0001A |
|
25 |
20 |
$817.76 |
| D1351 |
Sealant - per tooth |
154 |
24 |
$750.08 |
| 0012A |
|
25 |
18 |
$606.64 |
| 90716 |
|
120 |
112 |
$541.50 |
| 90461 |
|
840 |
789 |
$540.48 |
| 90734 |
|
142 |
134 |
$539.55 |
| 0002A |
|
16 |
12 |
$537.76 |
| 90686 |
|
334 |
304 |
$505.00 |
| 90651 |
|
166 |
158 |
$369.70 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
27 |
24 |
$356.73 |
| 90707 |
|
127 |
116 |
$342.69 |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$307.44 |
| 99173 |
|
108 |
97 |
$276.94 |
| 90619 |
|
44 |
44 |
$258.86 |
| 90696 |
|
48 |
42 |
$174.92 |
| 90670 |
|
43 |
40 |
$160.66 |
| 90633 |
|
133 |
118 |
$59.26 |
| 36416 |
|
16 |
14 |
$26.80 |
| 90674 |
|
26 |
26 |
$0.00 |
| 90723 |
|
12 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
14 |
$0.00 |