| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,436 |
3,298 |
$116K |
| D1351 |
Sealant - per tooth |
4,918 |
1,426 |
$99K |
| D1110 |
Prophylaxis - adult |
2,153 |
1,900 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,339 |
2,929 |
$66K |
| D1120 |
Prophylaxis - child |
2,734 |
2,405 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,542 |
1,394 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,007 |
1,859 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,056 |
823 |
$25K |
| D0274 |
Bitewings - four radiographic images |
896 |
795 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
281 |
188 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
149 |
$19K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
856 |
804 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
55 |
$10K |
| D0272 |
Bitewings - two radiographic images |
409 |
334 |
$6K |
| 90716 |
|
534 |
524 |
$6K |
| 90715 |
|
775 |
737 |
$5K |
| 90707 |
|
504 |
495 |
$4K |
| 90651 |
|
388 |
382 |
$4K |
| 90746 |
|
54 |
52 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
391 |
359 |
$2K |
| 90734 |
|
795 |
778 |
$2K |
| 90688 |
|
158 |
152 |
$1K |
| 86580 |
|
446 |
266 |
$1K |
| 90670 |
|
358 |
346 |
$1K |
| 99401 |
|
58 |
49 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| 90636 |
|
13 |
13 |
$993.18 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
24 |
24 |
$316.83 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$293.54 |
| 36415 |
Collection of venous blood by venipuncture |
87 |
84 |
$168.27 |
| 90619 |
|
42 |
42 |
$158.06 |
| 90686 |
|
364 |
363 |
$123.30 |
| 90713 |
|
329 |
319 |
$29.00 |
| 36416 |
|
14 |
13 |
$10.89 |
| 90698 |
|
73 |
70 |
$0.00 |
| 90744 |
|
154 |
152 |
$0.00 |
| 90680 |
|
25 |
25 |
$0.00 |
| 90696 |
|
42 |
42 |
$0.00 |
| 90633 |
|
483 |
473 |
$0.00 |
| 90700 |
|
336 |
325 |
$0.00 |
| 90461 |
|
147 |
145 |
$0.00 |
| 90685 |
|
30 |
30 |
$0.00 |
| 90648 |
|
68 |
63 |
$0.00 |