| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
577 |
554 |
$42K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,002 |
970 |
$39K |
| 99401 |
|
859 |
772 |
$25K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
220 |
216 |
$14K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,060 |
1,020 |
$11K |
| D1206 |
Topical application of fluoride varnish |
623 |
615 |
$10K |
| D0190 |
|
564 |
556 |
$5K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
131 |
125 |
$2K |
| 99177 |
|
243 |
224 |
$2K |
| 85018 |
|
631 |
603 |
$2K |
| 36416 |
|
637 |
609 |
$1K |
| 92551 |
|
132 |
126 |
$951.81 |
| 0001A |
|
23 |
21 |
$828.88 |
| 94250 |
|
43 |
39 |
$806.12 |
| 91322 |
|
18 |
12 |
$800.10 |
| 99173 |
|
252 |
248 |
$755.73 |
| 81025 |
|
112 |
105 |
$634.80 |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$527.09 |
| 90686 |
|
263 |
260 |
$430.85 |
| 96127 |
|
81 |
79 |
$347.59 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
12 |
$307.10 |
| 90480 |
|
19 |
13 |
$247.65 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
28 |
28 |
$233.02 |
| 90688 |
|
15 |
12 |
$80.00 |
| 90461 |
|
242 |
234 |
$0.00 |
| 90670 |
|
14 |
12 |
$0.00 |
| 90707 |
|
12 |
12 |
$0.00 |
| 90674 |
|
40 |
40 |
$0.00 |
| D1330 |
|
36 |
35 |
$0.00 |