| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
792 |
695 |
$13K |
| 91320 |
|
51 |
39 |
$3K |
| T1002 |
Rn services, up to 15 minutes |
71 |
35 |
$2K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
34 |
19 |
$2K |
| 0064A |
|
17 |
13 |
$624.96 |
| 90686 |
|
183 |
167 |
$565.39 |
| 90480 |
|
51 |
39 |
$540.77 |
| D1206 |
Topical application of fluoride varnish |
14 |
12 |
$306.42 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
18 |
13 |
$280.84 |
| 90656 |
|
331 |
284 |
$268.20 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
34 |
19 |
$195.89 |
| 90473 |
|
24 |
23 |
$138.64 |
| 36416 |
|
30 |
16 |
$113.76 |
| 85018 |
|
30 |
16 |
$43.95 |
| 90734 |
|
15 |
15 |
$0.00 |
| 90653 |
|
31 |
27 |
$0.00 |
| 91301 |
|
71 |
65 |
$0.00 |
| 90651 |
|
25 |
24 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
97 |
34 |
$0.00 |