| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,659 |
4,524 |
$245K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,920 |
3,826 |
$145K |
| D1206 |
Topical application of fluoride varnish |
5,072 |
4,848 |
$88K |
| 90461 |
|
1,990 |
1,958 |
$60K |
| D0191 |
|
5,340 |
5,208 |
$51K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
750 |
742 |
$49K |
| D1351 |
Sealant - per tooth |
744 |
724 |
$45K |
| 90734 |
|
302 |
299 |
$8K |
| 90633 |
|
1,630 |
1,616 |
$8K |
| 90651 |
|
149 |
147 |
$7K |
| 86480 |
|
60 |
60 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
114 |
108 |
$4K |
| D1110 |
Prophylaxis - adult |
57 |
57 |
$3K |
| 90686 |
|
399 |
395 |
$2K |
| 90670 |
|
508 |
506 |
$1K |
| 99383 |
|
12 |
12 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
58 |
58 |
$809.43 |
| 90715 |
|
228 |
227 |
$772.81 |
| 90648 |
|
129 |
128 |
$680.80 |
| 90710 |
|
349 |
347 |
$460.03 |
| 36415 |
Collection of venous blood by venipuncture |
410 |
409 |
$321.00 |
| 90723 |
|
86 |
85 |
$312.80 |
| 90713 |
|
17 |
16 |
$184.00 |
| 92551 |
|
17 |
17 |
$177.82 |
| 90716 |
|
17 |
15 |
$128.80 |
| 90680 |
|
43 |
39 |
$92.02 |
| 90696 |
|
54 |
54 |
$92.01 |
| 90700 |
|
13 |
13 |
$73.60 |
| 90656 |
|
12 |
12 |
$73.60 |
| 99173 |
|
17 |
17 |
$37.80 |
| 90698 |
|
66 |
65 |
$0.04 |
| D0602 |
|
1,264 |
1,185 |
$0.00 |
| D0603 |
|
3,034 |
3,011 |
$0.00 |
| D1330 |
|
4,788 |
4,682 |
$0.00 |
| 90744 |
|
14 |
13 |
$0.00 |
| D0601 |
|
336 |
336 |
$0.00 |
| D1310 |
|
1,343 |
1,326 |
$0.00 |
| D1320 |
|
365 |
365 |
$0.00 |
| 90677 |
|
13 |
13 |
$0.00 |