| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,822 |
1,752 |
$80K |
| 99401 |
|
1,008 |
926 |
$28K |
| D1206 |
Topical application of fluoride varnish |
307 |
307 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
450 |
424 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
69 |
66 |
$5K |
| 90651 |
|
126 |
116 |
$4K |
| D0190 |
|
307 |
307 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
43 |
41 |
$3K |
| 81025 |
|
444 |
411 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
149 |
132 |
$1K |
| 0001A |
|
28 |
22 |
$832.20 |
| 90715 |
|
220 |
216 |
$825.46 |
| 90734 |
|
84 |
74 |
$469.16 |
| 90686 |
|
236 |
233 |
$430.00 |
| 90688 |
|
20 |
18 |
$270.00 |
| 90707 |
|
46 |
43 |
$256.12 |
| 85018 |
|
90 |
78 |
$227.89 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
13 |
13 |
$212.12 |
| 36416 |
|
105 |
93 |
$210.62 |
| 90716 |
|
43 |
41 |
$115.17 |
| 99173 |
|
27 |
24 |
$84.26 |
| 96127 |
|
13 |
13 |
$54.23 |
| 90461 |
|
1,157 |
1,118 |
$22.52 |
| 90696 |
|
29 |
29 |
$0.00 |
| 90647 |
|
37 |
37 |
$0.00 |
| 90700 |
|
13 |
12 |
$0.00 |
| 90633 |
|
14 |
12 |
$0.00 |
| 90710 |
|
38 |
38 |
$0.00 |
| 90670 |
|
114 |
99 |
$0.00 |