| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,586 |
1,572 |
$93K |
| D0191 |
|
1,710 |
1,694 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,678 |
1,667 |
$31K |
| D1351 |
Sealant - per tooth |
282 |
277 |
$22K |
| 90632 |
|
276 |
273 |
$16K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
433 |
431 |
$16K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
280 |
267 |
$16K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
280 |
267 |
$16K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
180 |
172 |
$11K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
476 |
469 |
$10K |
| D1110 |
Prophylaxis - adult |
68 |
67 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
77 |
66 |
$3K |
| 90686 |
|
186 |
185 |
$1K |
| 90461 |
|
14 |
14 |
$570.40 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
23 |
16 |
$420.44 |
| 90688 |
|
36 |
36 |
$347.10 |
| 90633 |
|
86 |
86 |
$239.20 |
| 86803 |
|
12 |
12 |
$204.62 |
| 86580 |
|
19 |
14 |
$129.96 |
| 86780 |
|
12 |
12 |
$99.45 |
| D1330 |
|
186 |
186 |
$0.00 |
| D1310 |
|
168 |
168 |
$0.00 |
| D0603 |
|
195 |
194 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
21 |
21 |
$0.00 |
| 90734 |
|
28 |
28 |
$0.00 |
| 90682 |
|
18 |
18 |
$0.00 |