| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,705 |
4,427 |
$157K |
| 99401 |
|
3,036 |
2,579 |
$79K |
| D1206 |
Topical application of fluoride varnish |
2,132 |
2,103 |
$41K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
328 |
296 |
$24K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,264 |
1,135 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
316 |
162 |
$18K |
| D0190 |
|
1,366 |
1,344 |
$15K |
| D1120 |
Prophylaxis - child |
348 |
347 |
$12K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
140 |
129 |
$11K |
| 81025 |
|
2,163 |
1,788 |
$10K |
| D0330 |
Panoramic radiographic image |
342 |
332 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
316 |
316 |
$8K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
724 |
660 |
$8K |
| 92551 |
|
993 |
873 |
$7K |
| 90651 |
|
416 |
384 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
212 |
211 |
$5K |
| 83655 |
|
319 |
271 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
179 |
169 |
$4K |
| 96127 |
|
954 |
846 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
96 |
77 |
$4K |
| 94250 |
|
246 |
162 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
404 |
79 |
$4K |
| D0272 |
Bitewings - two radiographic images |
203 |
203 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
239 |
232 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
28 |
27 |
$2K |
| 99173 |
|
745 |
665 |
$2K |
| 99383 |
|
21 |
14 |
$2K |
| 36416 |
|
740 |
656 |
$2K |
| 90734 |
|
235 |
227 |
$1K |
| 85018 |
|
488 |
434 |
$1K |
| D0274 |
Bitewings - four radiographic images |
82 |
82 |
$1K |
| 99201 |
|
49 |
40 |
$1K |
| 90715 |
|
403 |
390 |
$1K |
| 90716 |
|
238 |
207 |
$1K |
| 90686 |
|
1,969 |
1,870 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
517 |
456 |
$980.11 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
38 |
30 |
$916.11 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
158 |
123 |
$882.73 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$874.63 |
| 0002A |
|
26 |
24 |
$868.88 |
| 99177 |
|
143 |
115 |
$832.57 |
| 90707 |
|
295 |
259 |
$813.44 |
| D1351 |
Sealant - per tooth |
105 |
44 |
$580.14 |
| 0001A |
|
23 |
22 |
$574.44 |
| 90670 |
|
253 |
232 |
$321.32 |
| 90461 |
|
1,994 |
1,886 |
$157.64 |
| 90619 |
|
46 |
45 |
$129.43 |
| 90633 |
|
494 |
458 |
$35.04 |
| 90656 |
|
17 |
17 |
$23.53 |
| 90744 |
|
42 |
39 |
$0.00 |
| 90698 |
|
143 |
133 |
$0.00 |
| 90696 |
|
55 |
44 |
$0.00 |
| 90688 |
|
23 |
22 |
$0.00 |
| 90710 |
|
31 |
31 |
$0.00 |