| Code | Description | Claims | Beneficiaries | Total Paid |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,482 |
3,302 |
$129K |
| 99401 |
|
871 |
794 |
$25K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
185 |
159 |
$13K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
766 |
698 |
$11K |
| D1206 |
Topical application of fluoride varnish |
730 |
726 |
$10K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
153 |
140 |
$10K |
| 83655 |
|
768 |
725 |
$8K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
738 |
670 |
$7K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
289 |
249 |
$7K |
| 81025 |
|
1,439 |
1,287 |
$6K |
| D0190 |
|
638 |
636 |
$5K |
| 99402 |
|
70 |
70 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
35 |
33 |
$2K |
| 90715 |
|
431 |
420 |
$2K |
| 92551 |
|
235 |
208 |
$2K |
| 90651 |
|
249 |
234 |
$2K |
| 90688 |
|
472 |
460 |
$2K |
| 0001A |
|
45 |
42 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
152 |
146 |
$1K |
| 85018 |
|
605 |
544 |
$1K |
| 0002A |
|
37 |
36 |
$1K |
| 90686 |
|
1,092 |
1,071 |
$945.00 |
| 36416 |
|
651 |
585 |
$882.20 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
55 |
54 |
$761.26 |
| 90734 |
|
146 |
143 |
$755.37 |
| 90716 |
|
194 |
178 |
$691.02 |
| 99177 |
|
128 |
109 |
$680.71 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$581.29 |
| 36415 |
Collection of venous blood by venipuncture |
334 |
304 |
$556.39 |
| 90619 |
|
81 |
73 |
$517.72 |
| 96127 |
|
129 |
113 |
$479.79 |
| 90707 |
|
177 |
161 |
$293.77 |
| 99173 |
|
76 |
68 |
$192.18 |
| 90670 |
|
172 |
157 |
$160.66 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$146.40 |
| 90461 |
|
1,431 |
1,335 |
$123.86 |
| 90633 |
|
150 |
142 |
$88.89 |
| 90697 |
|
13 |
12 |
$0.00 |
| 90647 |
|
54 |
49 |
$0.00 |
| 90723 |
|
14 |
12 |
$0.00 |
| 90696 |
|
35 |
28 |
$0.00 |
| 90677 |
|
14 |
13 |
$0.00 |