| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,962 |
1,660 |
$717K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
346 |
316 |
$77K |
| D1206 |
Topical application of fluoride varnish |
1,559 |
1,359 |
$20K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
96 |
90 |
$18K |
| D1120 |
Prophylaxis - child |
987 |
865 |
$17K |
| D0350 |
|
269 |
252 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
49 |
47 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
16 |
12 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$832.78 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
101 |
81 |
$416.39 |
| D0120 |
Periodic oral evaluation - established patient |
356 |
302 |
$333.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
61 |
53 |
$252.00 |
| 90656 |
|
27 |
24 |
$26.25 |
| 90686 |
|
25 |
25 |
$20.61 |
| D9996 |
|
935 |
788 |
$1.63 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
256 |
239 |
$0.00 |
| 3074F |
|
23 |
23 |
$0.00 |
| 85018 |
|
15 |
15 |
$0.00 |
| 3078F |
|
22 |
22 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12 |
12 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
61 |
27 |
$0.00 |
| 1159F |
|
53 |
49 |
$0.00 |