| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
1,995 |
1,643 |
$212K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,456 |
4,348 |
$75K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,587 |
1,381 |
$40K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,540 |
1,501 |
$16K |
| 90686 |
|
1,950 |
1,903 |
$11K |
| T1002 |
Rn services, up to 15 minutes |
922 |
894 |
$11K |
| 92567 |
|
418 |
415 |
$6K |
| D1206 |
Topical application of fluoride varnish |
154 |
151 |
$4K |
| 91322 |
|
32 |
31 |
$3K |
| 0001A |
|
152 |
150 |
$3K |
| 90651 |
|
236 |
230 |
$3K |
| 99188 |
|
91 |
90 |
$2K |
| 90662 |
|
60 |
53 |
$2K |
| 91320 |
|
47 |
43 |
$2K |
| 0002A |
|
121 |
118 |
$2K |
| 90656 |
|
175 |
175 |
$2K |
| 90480 |
|
108 |
103 |
$2K |
| 0012A |
|
64 |
56 |
$1K |
| 0011A |
|
72 |
65 |
$1K |
| 36416 |
|
45 |
44 |
$316.62 |
| 90715 |
|
43 |
43 |
$312.98 |
| 0064A |
|
16 |
13 |
$310.68 |
| 90707 |
|
13 |
13 |
$284.14 |
| 90670 |
|
54 |
53 |
$205.11 |
| 90620 |
|
73 |
70 |
$160.75 |
| 90688 |
|
40 |
40 |
$71.36 |
| 91301 |
|
200 |
174 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
40 |
40 |
$0.00 |
| 90696 |
|
13 |
13 |
$0.00 |
| 91307 |
|
15 |
15 |
$0.00 |
| 91300 |
|
381 |
320 |
$0.00 |
| 90734 |
|
131 |
127 |
$0.00 |
| 90633 |
|
26 |
26 |
$0.00 |
| 90621 |
|
12 |
12 |
$0.00 |
| 90685 |
|
44 |
44 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |