| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99401 |
|
1,028 |
958 |
$30K |
| 99381 |
|
208 |
199 |
$16K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
266 |
255 |
$12K |
| D1206 |
Topical application of fluoride varnish |
600 |
596 |
$11K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
153 |
141 |
$10K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
891 |
847 |
$9K |
| 81025 |
|
889 |
824 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
63 |
57 |
$4K |
| D0190 |
|
365 |
364 |
$4K |
| D1120 |
Prophylaxis - child |
72 |
71 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
58 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
80 |
78 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
44 |
43 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
28 |
27 |
$634.40 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$500.31 |
| 85018 |
|
160 |
134 |
$398.43 |
| 36416 |
|
168 |
141 |
$336.46 |
| 36415 |
Collection of venous blood by venipuncture |
77 |
74 |
$165.36 |
| 92551 |
|
12 |
12 |
$89.12 |
| 99173 |
|
12 |
12 |
$40.28 |
| 90686 |
|
19 |
19 |
$0.00 |
| 90461 |
|
138 |
135 |
$0.00 |