| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,086 |
1,008 |
$46K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
139 |
134 |
$9K |
| 99381 |
|
101 |
91 |
$8K |
| D1206 |
Topical application of fluoride varnish |
375 |
374 |
$7K |
| D1120 |
Prophylaxis - child |
177 |
176 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
539 |
504 |
$5K |
| D0190 |
|
134 |
134 |
$2K |
| 92551 |
|
178 |
164 |
$1K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
44 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
33 |
33 |
$1K |
| 99401 |
|
27 |
27 |
$892.78 |
| 96127 |
|
166 |
152 |
$657.60 |
| 99173 |
|
157 |
141 |
$491.23 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$481.78 |
| 81025 |
|
90 |
81 |
$465.73 |
| 90688 |
|
239 |
220 |
$410.00 |
| 90651 |
|
109 |
105 |
$362.55 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
12 |
$319.63 |
| 90715 |
|
91 |
87 |
$225.66 |
| 36415 |
Collection of venous blood by venipuncture |
91 |
81 |
$173.08 |
| 90619 |
|
15 |
15 |
$129.43 |
| 36416 |
|
15 |
12 |
$30.15 |
| 90461 |
|
192 |
183 |
$22.52 |
| 90656 |
|
13 |
12 |
$0.00 |
| 90686 |
|
12 |
12 |
$0.00 |
| 90648 |
|
44 |
44 |
$0.00 |
| 90670 |
|
42 |
42 |
$0.00 |
| 90633 |
|
13 |
13 |
$0.00 |
| 90734 |
|
37 |
36 |
$0.00 |