| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,075 |
2,864 |
$93K |
| D1120 |
Prophylaxis - child |
804 |
802 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,333 |
1,322 |
$24K |
| 99401 |
|
601 |
553 |
$17K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
210 |
202 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
530 |
525 |
$12K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
566 |
538 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
212 |
212 |
$5K |
| D1110 |
Prophylaxis - adult |
115 |
115 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
64 |
60 |
$5K |
| D0330 |
Panoramic radiographic image |
147 |
145 |
$4K |
| D0272 |
Bitewings - two radiographic images |
224 |
224 |
$4K |
| 92551 |
|
540 |
487 |
$4K |
| 90651 |
|
242 |
222 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
119 |
119 |
$3K |
| D0190 |
|
211 |
211 |
$2K |
| 0001A |
|
64 |
45 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
121 |
113 |
$2K |
| 96127 |
|
405 |
369 |
$2K |
| 81025 |
|
268 |
244 |
$1K |
| 99173 |
|
445 |
397 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$1K |
| 90686 |
|
1,361 |
1,332 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
14 |
$845.02 |
| D0274 |
Bitewings - four radiographic images |
34 |
33 |
$820.12 |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$658.80 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
65 |
60 |
$430.31 |
| 99177 |
|
28 |
28 |
$284.85 |
| 90716 |
|
61 |
52 |
$245.83 |
| 85018 |
|
77 |
69 |
$214.48 |
| 36416 |
|
91 |
83 |
$205.81 |
| 83655 |
|
13 |
12 |
$176.62 |
| 90707 |
|
62 |
53 |
$165.71 |
| 90734 |
|
101 |
96 |
$107.91 |
| 90461 |
|
605 |
556 |
$56.30 |
| 90715 |
|
62 |
60 |
$37.61 |
| D1330 |
|
95 |
95 |
$0.00 |
| 90619 |
|
28 |
25 |
$0.00 |
| 90647 |
|
13 |
13 |
$0.00 |
| 90674 |
|
66 |
66 |
$0.00 |
| 90670 |
|
13 |
12 |
$0.00 |
| 90633 |
|
14 |
12 |
$0.00 |