| 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) |
4,808 |
4,552 |
$590K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
7,466 |
7,022 |
$116K |
| T1002 |
Rn services, up to 15 minutes |
5,087 |
4,789 |
$101K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
5,655 |
2,827 |
$84K |
| 99188 |
|
2,937 |
2,772 |
$73K |
| T1001 |
Nursing assessment / evaluation |
4,586 |
4,347 |
$71K |
| 36416 |
|
5,429 |
4,111 |
$35K |
| D1206 |
Topical application of fluoride varnish |
894 |
880 |
$22K |
| 91320 |
|
206 |
187 |
$17K |
| 96127 |
|
2,770 |
1,880 |
$13K |
| 0124A |
|
399 |
394 |
$12K |
| 0001A |
|
579 |
486 |
$12K |
| 0002A |
|
473 |
417 |
$11K |
| 83655 |
|
945 |
886 |
$11K |
| T1003 |
Lpn/lvn services, up to 15 minutes |
566 |
528 |
$10K |
| 90480 |
|
594 |
551 |
$10K |
| 85018 |
|
4,319 |
4,105 |
$9K |
| 90686 |
|
3,271 |
3,081 |
$9K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
885 |
723 |
$9K |
| 0031A |
|
157 |
151 |
$7K |
| 0071A |
|
407 |
407 |
$7K |
| 0072A |
|
396 |
396 |
$7K |
| 0052A |
|
162 |
161 |
$6K |
| 0004A |
|
131 |
111 |
$5K |
| 0054A |
|
185 |
181 |
$5K |
| 0051A |
|
138 |
138 |
$4K |
| 0064A |
|
103 |
93 |
$4K |
| 90750 |
|
16 |
16 |
$3K |
| 90651 |
|
872 |
815 |
$2K |
| 0154A |
|
124 |
123 |
$2K |
| 0081A |
|
118 |
118 |
$2K |
| 90662 |
|
46 |
46 |
$2K |
| 0074A |
|
84 |
84 |
$1K |
| 0082A |
|
80 |
79 |
$1K |
| 0173A |
|
78 |
77 |
$1K |
| 94760 |
|
642 |
594 |
$1K |
| 90710 |
|
490 |
447 |
$1K |
| 90656 |
|
255 |
254 |
$1K |
| 0011A |
|
59 |
56 |
$1K |
| 90715 |
|
257 |
238 |
$921.61 |
| 90670 |
|
751 |
690 |
$665.00 |
| 0012A |
|
34 |
34 |
$614.98 |
| 90677 |
|
15 |
15 |
$288.66 |
| 90674 |
|
35 |
35 |
$220.00 |
| 90688 |
|
362 |
349 |
$17.84 |
| 90723 |
|
422 |
387 |
$0.00 |
| 91305 |
|
575 |
538 |
$0.00 |
| 90620 |
|
65 |
64 |
$0.00 |
| 91307 |
|
959 |
868 |
$0.00 |
| 90647 |
|
432 |
390 |
$0.00 |
| 90696 |
|
169 |
154 |
$0.00 |
| 91301 |
|
156 |
140 |
$0.00 |
| 91303 |
|
157 |
151 |
$0.00 |
| 91306 |
|
99 |
91 |
$0.00 |
| 91317 |
|
60 |
59 |
$0.00 |
| 91315 |
|
87 |
86 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
28 |
28 |
$0.00 |
| 90685 |
|
81 |
81 |
$0.00 |
| 91312 |
|
357 |
352 |
$0.00 |
| 91300 |
|
1,240 |
993 |
$0.00 |
| 90734 |
|
440 |
403 |
$0.00 |
| 90633 |
|
392 |
357 |
$0.00 |
| 91308 |
|
237 |
230 |
$0.00 |
| 90671 |
|
44 |
43 |
$0.00 |
| 90681 |
|
16 |
12 |
$0.00 |