| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,789 |
2,755 |
$66K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
957 |
950 |
$31K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
704 |
695 |
$21K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
433 |
433 |
$14K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
385 |
377 |
$12K |
| 90461 |
|
1,026 |
1,010 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
187 |
186 |
$4K |
| 90658 |
|
218 |
217 |
$821.37 |
| 90734 |
|
14 |
14 |
$501.84 |
| 86580 |
|
68 |
68 |
$299.20 |
| 90698 |
|
47 |
47 |
$92.70 |
| 90685 |
|
16 |
16 |
$76.44 |
| 92552 |
|
1,351 |
1,350 |
$24.20 |
| 99173 |
|
1,181 |
1,181 |
$0.00 |
| 90744 |
|
12 |
12 |
$0.00 |