| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99401 |
|
2,876 |
2,585 |
$81K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,329 |
2,247 |
$77K |
| D1206 |
Topical application of fluoride varnish |
3,017 |
2,989 |
$56K |
| 99381 |
|
443 |
432 |
$35K |
| D0330 |
Panoramic radiographic image |
984 |
961 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
824 |
812 |
$23K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
337 |
332 |
$22K |
| D1120 |
Prophylaxis - child |
694 |
688 |
$21K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,225 |
1,160 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
627 |
612 |
$15K |
| D1110 |
Prophylaxis - adult |
328 |
325 |
$13K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,225 |
1,176 |
$13K |
| D0190 |
|
1,167 |
1,152 |
$13K |
| D0274 |
Bitewings - four radiographic images |
493 |
479 |
$11K |
| 81025 |
|
1,835 |
1,642 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
384 |
384 |
$9K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
111 |
106 |
$8K |
| D0272 |
Bitewings - two radiographic images |
391 |
385 |
$6K |
| D1351 |
Sealant - per tooth |
690 |
72 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
320 |
303 |
$4K |
| 94250 |
|
184 |
154 |
$3K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
157 |
143 |
$3K |
| D2140 |
|
48 |
43 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
37 |
31 |
$2K |
| 92551 |
|
302 |
269 |
$2K |
| 90651 |
|
118 |
114 |
$2K |
| 0001A |
|
53 |
47 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
57 |
53 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
54 |
54 |
$1K |
| 0002A |
|
33 |
28 |
$1K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
14 |
14 |
$1K |
| 96127 |
|
265 |
236 |
$1K |
| 99173 |
|
327 |
295 |
$917.10 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28 |
24 |
$884.58 |
| 36416 |
|
374 |
339 |
$851.24 |
| D1354 |
|
110 |
26 |
$698.69 |
| 85018 |
|
224 |
201 |
$611.25 |
| 99071 |
|
193 |
172 |
$560.00 |
| 90686 |
|
804 |
795 |
$553.71 |
| 36415 |
Collection of venous blood by venipuncture |
145 |
133 |
$322.97 |
| 90715 |
|
98 |
95 |
$296.11 |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
14 |
$226.75 |
| 90734 |
|
48 |
45 |
$215.82 |
| 83655 |
|
13 |
13 |
$195.48 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
21 |
14 |
$139.66 |
| 90688 |
|
31 |
31 |
$50.00 |
| 99000 |
|
13 |
12 |
$0.00 |
| D1330 |
|
147 |
140 |
$0.00 |
| 90716 |
|
42 |
40 |
$0.00 |
| 90674 |
|
59 |
59 |
$0.00 |
| 90461 |
|
664 |
630 |
$0.00 |
| 90707 |
|
52 |
50 |
$0.00 |
| 90658 |
|
48 |
48 |
$0.00 |
| 90633 |
|
24 |
24 |
$0.00 |
| 90670 |
|
17 |
12 |
$0.00 |