| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
693 |
660 |
$34K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
340 |
277 |
$10K |
| D1206 |
Topical application of fluoride varnish |
290 |
289 |
$5K |
| 96127 |
|
1,677 |
1,372 |
$5K |
| D0330 |
Panoramic radiographic image |
135 |
128 |
$4K |
| 0001A |
|
89 |
69 |
$3K |
| D0190 |
|
276 |
275 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
35 |
27 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
136 |
115 |
$2K |
| 99401 |
|
81 |
64 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
68 |
67 |
$2K |
| 0002A |
|
50 |
40 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
59 |
56 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
35 |
29 |
$2K |
| 0011A |
|
55 |
48 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
659 |
542 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
167 |
149 |
$941.19 |
| 81025 |
|
195 |
142 |
$917.42 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
26 |
$610.00 |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
14 |
12 |
$254.32 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
42 |
31 |
$242.19 |
| 90715 |
|
70 |
69 |
$223.70 |
| 90651 |
|
28 |
28 |
$184.85 |
| 90686 |
|
52 |
48 |
$175.00 |
| 90734 |
|
37 |
37 |
$107.91 |
| 87210 |
|
13 |
12 |
$39.47 |
| 90461 |
|
381 |
375 |
$22.52 |
| 90633 |
|
25 |
25 |
$0.00 |
| 90707 |
|
17 |
14 |
$0.00 |
| 90710 |
|
16 |
16 |
$0.00 |
| 90716 |
|
18 |
15 |
$0.00 |
| 90696 |
|
16 |
16 |
$0.00 |