| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,737 |
1,710 |
$70K |
| 90461 |
|
653 |
642 |
$38K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
477 |
464 |
$27K |
| 90632 |
|
168 |
166 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
424 |
412 |
$10K |
| 0012A |
|
247 |
244 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
123 |
123 |
$6K |
| 0011A |
|
251 |
247 |
$5K |
| 0001A |
|
119 |
119 |
$5K |
| 90746 |
|
70 |
70 |
$4K |
| 0002A |
|
102 |
102 |
$4K |
| D1206 |
Topical application of fluoride varnish |
175 |
169 |
$3K |
| 90688 |
|
240 |
238 |
$3K |
| 0064A |
|
98 |
79 |
$3K |
| 99173 |
|
1,005 |
987 |
$2K |
| 0031A |
|
50 |
48 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
79 |
76 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
57 |
52 |
$1K |
| 99381 |
|
14 |
14 |
$964.04 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
13 |
$758.89 |
| 90734 |
|
214 |
211 |
$738.00 |
| 90619 |
|
29 |
29 |
$574.00 |
| 90633 |
|
685 |
674 |
$513.30 |
| 86580 |
|
76 |
73 |
$513.00 |
| 92551 |
|
49 |
49 |
$512.54 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$403.71 |
| 90670 |
|
100 |
99 |
$331.20 |
| 90715 |
|
68 |
67 |
$216.16 |
| 90698 |
|
41 |
41 |
$110.40 |
| 90680 |
|
15 |
15 |
$36.80 |
| 90700 |
|
13 |
12 |
$36.80 |
| 91301 |
|
396 |
387 |
$0.00 |
| 91303 |
|
25 |
24 |
$0.00 |