| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,958 |
1,818 |
$64K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
556 |
513 |
$34K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
502 |
438 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,908 |
1,869 |
$32K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,349 |
1,205 |
$14K |
| D0190 |
|
1,236 |
1,229 |
$12K |
| 99401 |
|
310 |
259 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
350 |
321 |
$5K |
| D1120 |
Prophylaxis - child |
180 |
157 |
$5K |
| D1351 |
Sealant - per tooth |
503 |
79 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
140 |
119 |
$2K |
| D1110 |
Prophylaxis - adult |
42 |
42 |
$2K |
| 0001A |
|
57 |
41 |
$2K |
| 85018 |
|
624 |
527 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$1K |
| 36416 |
|
639 |
540 |
$1K |
| 99381 |
|
18 |
12 |
$1K |
| 0002A |
|
33 |
28 |
$1K |
| 83655 |
|
92 |
78 |
$964.12 |
| 92551 |
|
75 |
60 |
$532.52 |
| 90686 |
|
642 |
627 |
$475.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
24 |
24 |
$391.26 |
| 90651 |
|
30 |
28 |
$369.70 |
| 90715 |
|
131 |
112 |
$364.98 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$317.20 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$292.80 |
| 81025 |
|
56 |
39 |
$224.03 |
| 96127 |
|
46 |
37 |
$169.25 |
| 90670 |
|
29 |
24 |
$160.66 |
| 99173 |
|
51 |
40 |
$131.58 |
| 90734 |
|
45 |
41 |
$107.91 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$69.76 |
| D1330 |
|
111 |
90 |
$0.00 |
| 90674 |
|
113 |
111 |
$0.00 |
| 90696 |
|
12 |
12 |
$0.00 |
| 90461 |
|
557 |
501 |
$0.00 |
| 90633 |
|
32 |
26 |
$0.00 |