| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,212 |
1,044 |
$24K |
| 90686 |
|
808 |
793 |
$12K |
| D1999 |
|
477 |
477 |
$5K |
| D0190 |
|
290 |
290 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
132 |
124 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
114 |
114 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
65 |
58 |
$1K |
| 0001A |
|
12 |
12 |
$447.00 |
| 90661 |
|
29 |
29 |
$320.76 |
| 90734 |
|
27 |
25 |
$287.08 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
132 |
124 |
$0.00 |
| 90662 |
|
12 |
12 |
$0.00 |
| 0124A |
|
12 |
12 |
$0.00 |
| 91300 |
|
15 |
12 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
63 |
63 |
$0.00 |