| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,772 |
5,838 |
$1.14M |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,080 |
980 |
$71K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,096 |
935 |
$66K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,754 |
1,526 |
$48K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,873 |
2,481 |
$44K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
468 |
320 |
$20K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,197 |
579 |
$15K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
921 |
879 |
$12K |
| 90474 |
|
437 |
410 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
262 |
250 |
$7K |
| 99199 |
Unlisted special service, procedure or report |
1,014 |
1,014 |
$6K |
| D1206 |
Topical application of fluoride varnish |
265 |
250 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
295 |
273 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
39 |
25 |
$2K |
| 83655 |
|
106 |
101 |
$1K |
| 96161 |
|
192 |
180 |
$635.80 |
| 87807 |
|
15 |
15 |
$211.95 |
| 90734 |
|
20 |
14 |
$119.02 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
12 |
12 |
$108.72 |
| 90686 |
|
716 |
595 |
$102.62 |
| 92551 |
|
307 |
214 |
$70.16 |
| 90633 |
|
242 |
208 |
$64.28 |
| 90715 |
|
19 |
13 |
$38.93 |
| 99173 |
|
784 |
519 |
$22.00 |
| 90680 |
|
438 |
412 |
$0.00 |
| 90698 |
|
30 |
24 |
$0.00 |
| 90723 |
|
406 |
375 |
$0.00 |
| 90647 |
|
120 |
110 |
$0.00 |
| 90696 |
|
20 |
12 |
$0.00 |
| 90648 |
|
98 |
95 |
$0.00 |
| 90670 |
|
922 |
871 |
$0.00 |
| 90687 |
|
45 |
45 |
$0.00 |
| 90685 |
|
52 |
52 |
$0.00 |
| 90710 |
|
110 |
90 |
$0.00 |