| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,973 |
1,866 |
$92K |
| 99381 |
|
475 |
467 |
$38K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
499 |
491 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,107 |
1,065 |
$20K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,554 |
1,475 |
$15K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
204 |
162 |
$14K |
| 99401 |
|
344 |
315 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
447 |
444 |
$9K |
| D1120 |
Prophylaxis - child |
287 |
269 |
$8K |
| D0190 |
|
320 |
318 |
$4K |
| D0272 |
Bitewings - two radiographic images |
156 |
155 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
139 |
101 |
$2K |
| D0330 |
Panoramic radiographic image |
56 |
56 |
$2K |
| 85018 |
|
613 |
525 |
$2K |
| 81025 |
|
291 |
265 |
$2K |
| 92551 |
|
215 |
185 |
$2K |
| 0001A |
|
40 |
36 |
$1K |
| 36416 |
|
619 |
529 |
$1K |
| 90651 |
|
176 |
165 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
87 |
76 |
$1K |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$1K |
| 0002A |
|
35 |
27 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
39 |
39 |
$947.97 |
| 90734 |
|
177 |
165 |
$863.28 |
| 90715 |
|
334 |
307 |
$769.99 |
| D0274 |
Bitewings - four radiographic images |
33 |
24 |
$514.08 |
| 96127 |
|
117 |
97 |
$468.47 |
| 90716 |
|
145 |
129 |
$460.68 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
16 |
12 |
$390.76 |
| 90619 |
|
32 |
27 |
$258.86 |
| 90707 |
|
145 |
129 |
$256.12 |
| 99173 |
|
68 |
50 |
$216.23 |
| 36415 |
Collection of venous blood by venipuncture |
116 |
97 |
$210.22 |
| 90670 |
|
203 |
181 |
$160.66 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
18 |
16 |
$135.58 |
| 90686 |
|
296 |
283 |
$70.00 |
| 90633 |
|
113 |
95 |
$59.26 |
| 99177 |
|
12 |
12 |
$52.79 |
| 90461 |
|
1,352 |
1,289 |
$45.04 |
| 90647 |
|
135 |
123 |
$24.12 |
| 91300 |
|
18 |
18 |
$0.00 |
| 90710 |
|
16 |
16 |
$0.00 |
| D1330 |
|
72 |
72 |
$0.00 |
| 90723 |
|
43 |
39 |
$0.00 |