| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,178 |
4,000 |
$147K |
| 99401 |
|
2,566 |
2,225 |
$66K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
855 |
808 |
$54K |
| 99381 |
|
760 |
652 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,617 |
2,588 |
$49K |
| 99384 |
|
294 |
269 |
$31K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
314 |
296 |
$29K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
369 |
324 |
$26K |
| D0190 |
|
2,135 |
2,135 |
$24K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,405 |
2,164 |
$23K |
| 90651 |
|
538 |
499 |
$14K |
| 92551 |
|
1,631 |
1,456 |
$12K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
732 |
647 |
$11K |
| 81025 |
|
1,520 |
1,333 |
$7K |
| 94250 |
|
384 |
315 |
$7K |
| D1120 |
Prophylaxis - child |
181 |
180 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
207 |
$5K |
| D1110 |
Prophylaxis - adult |
122 |
122 |
$5K |
| 96127 |
|
1,298 |
1,171 |
$5K |
| 99173 |
|
1,468 |
1,329 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
178 |
$4K |
| 86580 |
|
527 |
488 |
$4K |
| 36416 |
|
1,363 |
1,247 |
$3K |
| 85018 |
|
1,044 |
955 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
123 |
123 |
$3K |
| 83655 |
|
189 |
146 |
$2K |
| D0274 |
Bitewings - four radiographic images |
73 |
73 |
$2K |
| 90734 |
|
296 |
281 |
$2K |
| 0001A |
|
50 |
45 |
$2K |
| D0330 |
Panoramic radiographic image |
48 |
48 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
191 |
167 |
$2K |
| 99177 |
|
223 |
203 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
15 |
$1K |
| 90686 |
|
1,410 |
1,382 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
593 |
506 |
$1K |
| 90716 |
|
220 |
209 |
$986.69 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$971.33 |
| 90715 |
|
244 |
233 |
$912.48 |
| 90707 |
|
234 |
217 |
$798.33 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
32 |
27 |
$796.66 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
17 |
15 |
$604.21 |
| D0272 |
Bitewings - two radiographic images |
31 |
30 |
$551.27 |
| 0002A |
|
17 |
14 |
$523.32 |
| 90621 |
|
49 |
42 |
$460.60 |
| D1351 |
Sealant - per tooth |
73 |
13 |
$410.20 |
| 90670 |
|
382 |
367 |
$321.32 |
| 99407 |
|
16 |
12 |
$241.50 |
| 96160 |
|
16 |
12 |
$127.37 |
| 90696 |
|
30 |
30 |
$94.34 |
| 90461 |
|
1,289 |
1,238 |
$56.30 |
| 90633 |
|
302 |
284 |
$29.63 |
| 90647 |
|
235 |
225 |
$24.12 |
| 90674 |
|
323 |
316 |
$0.00 |
| 90723 |
|
175 |
167 |
$0.00 |
| 99000 |
|
14 |
12 |
$0.00 |
| 91300 |
|
14 |
14 |
$0.00 |