| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,505 |
2,432 |
$122K |
| 99381 |
|
178 |
166 |
$14K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
189 |
177 |
$12K |
| D1206 |
Topical application of fluoride varnish |
522 |
521 |
$9K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
916 |
860 |
$9K |
| D0190 |
|
521 |
521 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
67 |
57 |
$5K |
| 99401 |
|
125 |
119 |
$4K |
| 99402 |
|
60 |
58 |
$3K |
| 0001A |
|
42 |
34 |
$1K |
| 90734 |
|
176 |
172 |
$1K |
| 90651 |
|
130 |
124 |
$1K |
| 81025 |
|
197 |
173 |
$969.63 |
| 90716 |
|
244 |
235 |
$821.68 |
| 90715 |
|
220 |
216 |
$780.87 |
| 90619 |
|
43 |
41 |
$388.29 |
| 90670 |
|
556 |
531 |
$321.32 |
| 90686 |
|
214 |
200 |
$285.21 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
13 |
12 |
$194.09 |
| 36416 |
|
97 |
85 |
$169.99 |
| 90688 |
|
13 |
12 |
$165.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
15 |
$156.94 |
| 90707 |
|
235 |
226 |
$128.06 |
| 90680 |
|
117 |
113 |
$77.60 |
| 90633 |
|
307 |
291 |
$59.26 |
| 96127 |
|
12 |
12 |
$50.71 |
| 90461 |
|
1,770 |
1,728 |
$45.04 |
| 99173 |
|
12 |
12 |
$42.19 |
| 85018 |
|
16 |
15 |
$41.60 |
| 90648 |
|
223 |
210 |
$19.83 |
| 90710 |
|
12 |
12 |
$0.00 |
| 90696 |
|
89 |
87 |
$0.00 |
| 90698 |
|
25 |
25 |
$0.00 |
| 90723 |
|
90 |
87 |
$0.00 |