| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,057 |
1,002 |
$40K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
149 |
115 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
37 |
33 |
$3K |
| 99401 |
|
72 |
52 |
$2K |
| 90688 |
|
477 |
458 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
132 |
115 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
143 |
128 |
$1K |
| D1206 |
Topical application of fluoride varnish |
46 |
46 |
$820.00 |
| 0001A |
|
21 |
17 |
$657.76 |
| 92551 |
|
82 |
70 |
$562.46 |
| D0190 |
|
46 |
46 |
$480.00 |
| 90715 |
|
55 |
55 |
$404.77 |
| 90651 |
|
48 |
48 |
$362.55 |
| 99173 |
|
85 |
75 |
$222.89 |
| 96127 |
|
35 |
27 |
$133.01 |
| 90734 |
|
34 |
34 |
$107.91 |
| 36416 |
|
70 |
69 |
$96.63 |
| 90461 |
|
330 |
313 |
$56.30 |
| 36415 |
Collection of venous blood by venipuncture |
30 |
28 |
$31.34 |
| 90716 |
|
46 |
41 |
$0.00 |
| 90686 |
|
27 |
27 |
$0.00 |
| 90696 |
|
13 |
13 |
$0.00 |
| 90707 |
|
45 |
41 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |