| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,052 |
1,954 |
$69K |
| 99401 |
|
259 |
218 |
$7K |
| D1206 |
Topical application of fluoride varnish |
273 |
263 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
398 |
359 |
$4K |
| D0190 |
|
261 |
251 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
45 |
44 |
$3K |
| 90651 |
|
120 |
111 |
$2K |
| 0001A |
|
37 |
36 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15 |
12 |
$972.18 |
| 81025 |
|
181 |
146 |
$943.36 |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$641.64 |
| 0002A |
|
21 |
19 |
$520.00 |
| 85018 |
|
170 |
157 |
$490.31 |
| 90686 |
|
482 |
463 |
$415.00 |
| 36416 |
|
163 |
146 |
$375.76 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$292.80 |
| 90734 |
|
94 |
87 |
$215.82 |
| 92551 |
|
19 |
14 |
$138.66 |
| 83655 |
|
13 |
13 |
$126.75 |
| 90707 |
|
75 |
74 |
$64.03 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15 |
13 |
$58.43 |
| 90715 |
|
51 |
48 |
$32.84 |
| 90633 |
|
146 |
131 |
$29.63 |
| 90670 |
|
522 |
496 |
$0.00 |
| 90461 |
|
936 |
884 |
$0.00 |
| 90681 |
|
30 |
27 |
$0.00 |
| 90647 |
|
151 |
145 |
$0.00 |
| 90723 |
|
298 |
283 |
$0.00 |
| 90716 |
|
58 |
57 |
$0.00 |
| 90688 |
|
351 |
346 |
$0.00 |