| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0451 |
Development testing, with interpretation and report, per standardized instrument form |
889 |
873 |
$53K |
| D0190 |
|
1,403 |
1,326 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,458 |
1,372 |
$19K |
| D1330 |
|
626 |
605 |
$9K |
| S5130 |
Homemaker service, nos; per 15 minutes |
311 |
127 |
$9K |
| 83655 |
|
470 |
443 |
$9K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
483 |
456 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
185 |
169 |
$3K |
| D1351 |
Sealant - per tooth |
111 |
47 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
281 |
266 |
$3K |
| 90686 |
|
200 |
189 |
$2K |
| 96127 |
|
40 |
38 |
$2K |
| D0602 |
|
1,571 |
1,476 |
$1K |
| 90734 |
|
15 |
15 |
$563.87 |
| D1310 |
|
27 |
27 |
$476.96 |
| D0603 |
|
37 |
30 |
$27.57 |
| 36416 |
|
14 |
14 |
$22.19 |