| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
376 |
363 |
$16K |
| D1206 |
Topical application of fluoride varnish |
612 |
611 |
$11K |
| D1120 |
Prophylaxis - child |
256 |
256 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
295 |
295 |
$7K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
342 |
291 |
$5K |
| 99401 |
|
177 |
156 |
$5K |
| D0330 |
Panoramic radiographic image |
92 |
90 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
40 |
$3K |
| D1110 |
Prophylaxis - adult |
69 |
69 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
125 |
109 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
115 |
$3K |
| D0190 |
|
226 |
225 |
$2K |
| D0274 |
Bitewings - four radiographic images |
88 |
88 |
$2K |
| 0001A |
|
49 |
38 |
$1K |
| 81025 |
|
311 |
261 |
$1K |
| 0002A |
|
19 |
17 |
$574.44 |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$481.78 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$337.81 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
56 |
53 |
$321.60 |
| 90715 |
|
68 |
66 |
$263.27 |
| 36415 |
Collection of venous blood by venipuncture |
135 |
113 |
$259.52 |
| 90716 |
|
26 |
25 |
$230.34 |
| 90619 |
|
16 |
16 |
$129.43 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
24 |
13 |
$113.64 |
| 90686 |
|
50 |
41 |
$45.00 |
| 90461 |
|
196 |
191 |
$0.00 |
| 90633 |
|
13 |
13 |
$0.00 |
| 90651 |
|
31 |
29 |
$0.00 |