| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,036 |
2,927 |
$147K |
| D1206 |
Topical application of fluoride varnish |
2,757 |
2,754 |
$51K |
| 99401 |
|
949 |
892 |
$27K |
| 99381 |
|
259 |
257 |
$21K |
| D0190 |
|
1,857 |
1,855 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
797 |
796 |
$19K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
276 |
271 |
$18K |
| D1120 |
Prophylaxis - child |
479 |
479 |
$16K |
| D1110 |
Prophylaxis - adult |
323 |
323 |
$14K |
| 99402 |
|
221 |
202 |
$10K |
| 81025 |
|
1,715 |
1,587 |
$9K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
540 |
509 |
$8K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
863 |
838 |
$8K |
| D0272 |
Bitewings - two radiographic images |
360 |
360 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
232 |
215 |
$6K |
| 90651 |
|
138 |
133 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
79 |
69 |
$3K |
| 90716 |
|
439 |
413 |
$2K |
| 0001A |
|
67 |
49 |
$2K |
| 90707 |
|
492 |
460 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
128 |
123 |
$1K |
| 90715 |
|
266 |
253 |
$1K |
| 0002A |
|
31 |
28 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
143 |
130 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
464 |
437 |
$792.26 |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$768.75 |
| D0274 |
Bitewings - four radiographic images |
30 |
30 |
$692.50 |
| 90686 |
|
277 |
270 |
$650.00 |
| 96127 |
|
142 |
127 |
$559.49 |
| 90677 |
|
66 |
65 |
$470.44 |
| 85018 |
|
164 |
140 |
$438.69 |
| 90734 |
|
50 |
48 |
$431.64 |
| 99173 |
|
111 |
106 |
$364.73 |
| 36416 |
|
172 |
147 |
$363.82 |
| 90688 |
|
89 |
87 |
$275.00 |
| 90619 |
|
17 |
13 |
$258.86 |
| 90671 |
|
100 |
92 |
$202.03 |
| 90461 |
|
2,238 |
2,164 |
$112.60 |
| 90633 |
|
387 |
373 |
$76.78 |
| 90696 |
|
174 |
173 |
$47.17 |
| 90723 |
|
217 |
210 |
$0.00 |
| 90697 |
|
80 |
77 |
$0.00 |
| 99000 |
|
22 |
16 |
$0.00 |
| 90670 |
|
533 |
515 |
$0.00 |
| 90648 |
|
334 |
323 |
$0.00 |
| 90681 |
|
46 |
45 |
$0.00 |
| 91300 |
|
20 |
20 |
$0.00 |
| 90700 |
|
25 |
25 |
$0.00 |
| 90713 |
|
15 |
15 |
$0.00 |
| 90710 |
|
18 |
18 |
$0.00 |