| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92587 |
|
354 |
207 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
207 |
127 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
218 |
136 |
$954.50 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
18 |
13 |
$429.77 |
| 96127 |
|
159 |
94 |
$95.84 |
| 90461 |
|
35 |
24 |
$70.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
13 |
$50.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
41 |
26 |
$50.00 |
| 90686 |
|
50 |
29 |
$41.42 |
| A4207 |
Syringe with needle, sterile 2 cc, each |
237 |
159 |
$6.20 |
| 99072 |
|
15 |
13 |
$0.00 |