| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
2,385 |
2,378 |
$47K |
| 99381 |
|
564 |
538 |
$44K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
911 |
852 |
$38K |
| 99401 |
|
1,288 |
1,163 |
$36K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
520 |
510 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
253 |
193 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
623 |
$17K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,402 |
1,341 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
137 |
$13K |
| D1120 |
Prophylaxis - child |
388 |
388 |
$13K |
| D0190 |
|
1,215 |
1,213 |
$13K |
| D0272 |
Bitewings - two radiographic images |
713 |
713 |
$10K |
| D1110 |
Prophylaxis - adult |
242 |
240 |
$10K |
| 81025 |
|
1,635 |
1,447 |
$8K |
| D0330 |
Panoramic radiographic image |
203 |
202 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
279 |
279 |
$7K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
413 |
375 |
$6K |
| D0274 |
Bitewings - four radiographic images |
232 |
229 |
$5K |
| D1351 |
Sealant - per tooth |
646 |
145 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
77 |
$2K |
| 92551 |
|
253 |
218 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
141 |
140 |
$2K |
| 0001A |
|
46 |
33 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15 |
15 |
$1K |
| D1354 |
|
188 |
31 |
$1K |
| 99173 |
|
357 |
318 |
$1K |
| 96127 |
|
250 |
219 |
$1K |
| 90651 |
|
38 |
37 |
$917.10 |
| 85018 |
|
331 |
299 |
$887.34 |
| 0002A |
|
25 |
18 |
$741.08 |
| 36416 |
|
337 |
302 |
$695.58 |
| 90734 |
|
55 |
52 |
$431.64 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
52 |
44 |
$419.79 |
| 90707 |
|
14 |
13 |
$395.45 |
| 90688 |
|
59 |
52 |
$350.00 |
| 90715 |
|
33 |
32 |
$145.67 |
| 36415 |
Collection of venous blood by venipuncture |
40 |
37 |
$48.40 |
| 90461 |
|
371 |
340 |
$22.52 |
| 90670 |
|
26 |
26 |
$0.00 |
| 99000 |
|
16 |
14 |
$0.00 |
| 90686 |
|
32 |
30 |
$0.00 |
| D1330 |
|
17 |
17 |
$0.00 |