| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
5,926 |
5,904 |
$99K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,703 |
1,599 |
$63K |
| D0190 |
|
5,660 |
5,638 |
$55K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
174 |
158 |
$12K |
| 99401 |
|
267 |
240 |
$8K |
| 99201 |
|
214 |
200 |
$7K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
636 |
583 |
$6K |
| D1120 |
Prophylaxis - child |
187 |
187 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
215 |
215 |
$5K |
| 83655 |
|
358 |
339 |
$4K |
| D1110 |
Prophylaxis - adult |
77 |
77 |
$3K |
| 90651 |
|
397 |
382 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
49 |
43 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
386 |
354 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |
| 0001A |
|
31 |
25 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
19 |
19 |
$933.88 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$774.33 |
| 36416 |
|
438 |
408 |
$744.98 |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$678.72 |
| 0002A |
|
16 |
16 |
$640.00 |
| D0272 |
Bitewings - two radiographic images |
32 |
32 |
$592.96 |
| D1351 |
Sealant - per tooth |
85 |
20 |
$586.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$380.25 |
| 85018 |
|
157 |
136 |
$346.45 |
| 90716 |
|
71 |
68 |
$345.51 |
| 90734 |
|
179 |
168 |
$323.73 |
| 92551 |
|
39 |
36 |
$285.41 |
| 90715 |
|
229 |
221 |
$263.27 |
| 90707 |
|
69 |
67 |
$192.09 |
| 90686 |
|
246 |
228 |
$165.00 |
| 90619 |
|
49 |
45 |
$129.43 |
| 99177 |
|
20 |
15 |
$118.68 |
| 90461 |
|
630 |
603 |
$67.56 |
| 90696 |
|
40 |
38 |
$47.17 |
| 90688 |
|
79 |
74 |
$0.00 |
| 99000 |
|
35 |
33 |
$0.00 |
| 90620 |
|
14 |
14 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 90633 |
|
89 |
85 |
$0.00 |
| 90621 |
|
48 |
41 |
$0.00 |