| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,481 |
4,782 |
$195K |
| D1351 |
Sealant - per tooth |
4,207 |
1,205 |
$89K |
| 0001A |
|
986 |
977 |
$44K |
| 0002A |
|
860 |
848 |
$34K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
1,457 |
1,425 |
$20K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,058 |
1,029 |
$18K |
| 0003A |
|
213 |
213 |
$18K |
| H1002 |
Prenatal care, at risk enhanced service; care coordination |
1,452 |
1,420 |
$17K |
| 90632 |
|
414 |
410 |
$15K |
| 0071A |
|
140 |
140 |
$13K |
| 0072A |
|
106 |
105 |
$10K |
| 0031A |
|
84 |
84 |
$6K |
| H1000 |
Prenatal care, at-risk assessment |
534 |
524 |
$6K |
| 90651 |
|
792 |
776 |
$6K |
| 90688 |
|
259 |
255 |
$5K |
| 0124A |
|
64 |
64 |
$4K |
| 0012A |
|
122 |
122 |
$4K |
| 0051A |
|
28 |
28 |
$3K |
| 0011A |
|
140 |
140 |
$2K |
| 91320 |
|
38 |
28 |
$2K |
| S9453 |
Smoking cessation classes, non-physician provider, per session |
120 |
71 |
$2K |
| 90480 |
|
50 |
34 |
$2K |
| 0052A |
|
16 |
16 |
$1K |
| 90620 |
|
246 |
241 |
$1K |
| D1206 |
Topical application of fluoride varnish |
89 |
89 |
$1K |
| 0053A |
|
12 |
12 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
55 |
37 |
$767.24 |
| 90715 |
|
414 |
413 |
$726.47 |
| 90734 |
|
586 |
582 |
$718.56 |
| 90658 |
|
30 |
30 |
$628.22 |
| 90686 |
|
985 |
959 |
$517.90 |
| 90633 |
|
844 |
836 |
$506.48 |
| T1023 |
Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter |
14 |
14 |
$386.00 |
| 99407 |
|
18 |
12 |
$355.30 |
| 99401 |
|
13 |
13 |
$353.83 |
| 90716 |
|
12 |
12 |
$330.27 |
| 86580 |
|
52 |
36 |
$293.50 |
| 90707 |
|
13 |
13 |
$181.62 |
| 90710 |
|
176 |
176 |
$36.66 |
| 90656 |
|
43 |
42 |
$23.47 |
| 91300 |
|
2,088 |
1,872 |
$1.20 |
| 91301 |
|
264 |
264 |
$1.12 |
| 91305 |
|
183 |
176 |
$0.19 |
| 91303 |
|
83 |
83 |
$0.08 |
| 91307 |
|
254 |
237 |
$0.07 |
| 91312 |
|
64 |
64 |
$0.03 |
| 90648 |
|
1,170 |
1,149 |
$0.00 |
| 90670 |
|
1,068 |
1,050 |
$0.00 |
| 90700 |
|
83 |
82 |
$0.00 |
| 90685 |
|
60 |
59 |
$0.00 |
| 90723 |
|
670 |
658 |
$0.00 |
| 90696 |
|
86 |
86 |
$0.00 |
| 90619 |
|
261 |
256 |
$0.00 |
| 90680 |
|
117 |
117 |
$0.00 |
| 90677 |
|
94 |
91 |
$0.00 |