| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,685 |
2,560 |
$113K |
| D1206 |
Topical application of fluoride varnish |
1,323 |
1,307 |
$24K |
| D0190 |
|
1,160 |
1,159 |
$13K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
142 |
127 |
$9K |
| 90651 |
|
549 |
517 |
$8K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
598 |
547 |
$6K |
| 99401 |
|
170 |
163 |
$5K |
| 99402 |
|
108 |
90 |
$5K |
| 81025 |
|
850 |
776 |
$4K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
258 |
236 |
$4K |
| 99381 |
|
28 |
28 |
$2K |
| 90734 |
|
356 |
348 |
$2K |
| 90715 |
|
434 |
421 |
$2K |
| 0001A |
|
49 |
37 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
81 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
180 |
158 |
$1K |
| 90686 |
|
714 |
684 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15 |
15 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
41 |
41 |
$976.00 |
| 0002A |
|
26 |
20 |
$777.76 |
| 90716 |
|
114 |
99 |
$691.02 |
| 96127 |
|
142 |
123 |
$568.83 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$546.34 |
| 90707 |
|
109 |
99 |
$448.21 |
| 90619 |
|
80 |
68 |
$388.29 |
| 92551 |
|
27 |
26 |
$193.83 |
| 90688 |
|
16 |
13 |
$180.00 |
| 90670 |
|
205 |
187 |
$160.66 |
| 90658 |
|
16 |
15 |
$160.00 |
| 90461 |
|
1,496 |
1,431 |
$112.60 |
| 90698 |
|
70 |
57 |
$82.64 |
| 99173 |
|
15 |
15 |
$47.56 |
| 90633 |
|
215 |
203 |
$29.63 |
| 36415 |
Collection of venous blood by venipuncture |
12 |
12 |
$27.23 |
| 90696 |
|
39 |
39 |
$0.00 |
| 90674 |
|
14 |
14 |
$0.00 |
| 90723 |
|
12 |
12 |
$0.00 |
| 90744 |
|
17 |
13 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |
| 91300 |
|
12 |
12 |
$0.00 |