| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96127 |
|
1,879 |
1,664 |
$101K |
| G0451 |
Development testing, with interpretation and report, per standardized instrument form |
1,356 |
1,346 |
$82K |
| 83655 |
|
1,543 |
1,442 |
$29K |
| D0190 |
|
1,641 |
1,641 |
$26K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,630 |
1,528 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,564 |
1,562 |
$21K |
| D1351 |
Sealant - per tooth |
158 |
121 |
$7K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
154 |
154 |
$6K |
| D1330 |
|
234 |
234 |
$4K |
| D0602 |
|
1,572 |
1,571 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$526.23 |
| 36416 |
|
83 |
82 |
$206.59 |
| D0603 |
|
88 |
88 |
$82.24 |
| 90461 |
|
58 |
58 |
$1.67 |
| 90688 |
|
44 |
44 |
$0.19 |
| 90734 |
|
28 |
28 |
$0.00 |