| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
959 |
947 |
$38K |
| D1351 |
Sealant - per tooth |
445 |
303 |
$37K |
| D0190 |
|
1,515 |
1,499 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,557 |
1,533 |
$20K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
265 |
236 |
$19K |
| D1330 |
|
237 |
230 |
$4K |
| 90461 |
|
306 |
299 |
$3K |
| 90686 |
|
341 |
336 |
$2K |
| D1310 |
|
120 |
115 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79 |
76 |
$1K |
| D0602 |
|
1,207 |
1,194 |
$983.80 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
78 |
75 |
$363.76 |
| 96160 |
|
47 |
25 |
$283.18 |
| D0603 |
|
224 |
224 |
$189.15 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$162.72 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
31 |
28 |
$113.70 |
| S4993 |
Contraceptive pills for birth control |
28 |
24 |
$41.40 |
| 90651 |
|
61 |
60 |
$0.00 |
| 90715 |
|
96 |
95 |
$0.00 |
| 90734 |
|
148 |
147 |
$0.00 |
| 90633 |
|
21 |
20 |
$0.00 |