| 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) |
1,184 |
1,151 |
$143K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
7,272 |
6,960 |
$110K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,829 |
1,749 |
$46K |
| 91320 |
|
399 |
361 |
$17K |
| 0001A |
|
433 |
392 |
$12K |
| 0002A |
|
380 |
348 |
$11K |
| T1002 |
Rn services, up to 15 minutes |
379 |
300 |
$7K |
| 0003A |
|
127 |
94 |
$7K |
| 90686 |
|
3,600 |
3,460 |
$6K |
| 36416 |
|
887 |
864 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
486 |
465 |
$5K |
| 90480 |
|
442 |
401 |
$4K |
| 90651 |
|
393 |
381 |
$4K |
| 0064A |
|
71 |
63 |
$4K |
| 0124A |
|
150 |
146 |
$3K |
| 0012A |
|
85 |
85 |
$3K |
| 0011A |
|
86 |
86 |
$2K |
| 90656 |
|
544 |
492 |
$2K |
| S0390 |
Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions (e.g., diabetes), per visit |
91 |
76 |
$1K |
| 0054A |
|
74 |
71 |
$1K |
| 0071A |
|
70 |
68 |
$1K |
| 90734 |
|
553 |
542 |
$1K |
| 0072A |
|
50 |
47 |
$759.92 |
| 90715 |
|
197 |
188 |
$629.09 |
| D1206 |
Topical application of fluoride varnish |
64 |
62 |
$610.00 |
| 99188 |
|
24 |
24 |
$600.00 |
| 0052A |
|
29 |
28 |
$512.18 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
54 |
53 |
$420.00 |
| 90688 |
|
365 |
364 |
$362.90 |
| 90621 |
|
234 |
230 |
$300.34 |
| 86703 |
|
54 |
53 |
$287.94 |
| 0031A |
|
17 |
13 |
$268.80 |
| 0051A |
|
15 |
14 |
$264.35 |
| 90756 |
|
34 |
33 |
$142.45 |
| 86780 |
|
37 |
37 |
$120.00 |
| 90653 |
|
65 |
60 |
$117.40 |
| 90694 |
|
34 |
27 |
$54.67 |
| 36415 |
Collection of venous blood by venipuncture |
13 |
13 |
$22.12 |
| 91300 |
|
971 |
798 |
$0.00 |
| 90670 |
|
14 |
14 |
$0.00 |
| 90633 |
|
103 |
98 |
$0.00 |
| 90710 |
|
49 |
42 |
$0.00 |
| 91312 |
|
115 |
111 |
$0.00 |
| 91305 |
|
208 |
198 |
$0.00 |
| 91307 |
|
143 |
124 |
$0.00 |
| 96127 |
|
658 |
647 |
$0.00 |
| 91301 |
|
218 |
209 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
199 |
171 |
$0.00 |
| 91303 |
|
17 |
13 |
$0.00 |
| 96161 |
|
12 |
12 |
$0.00 |
| 90696 |
|
27 |
27 |
$0.00 |
| 91306 |
|
71 |
63 |
$0.00 |
| 90647 |
|
13 |
13 |
$0.00 |
| 90723 |
|
14 |
14 |
$0.00 |