| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,457 |
2,247 |
$92K |
| D1206 |
Topical application of fluoride varnish |
164 |
164 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
147 |
115 |
$3K |
| D0190 |
|
164 |
164 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
167 |
147 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
19 |
14 |
$1K |
| 90688 |
|
779 |
677 |
$785.00 |
| 90715 |
|
290 |
270 |
$748.03 |
| 99402 |
|
15 |
13 |
$746.24 |
| 96127 |
|
122 |
95 |
$574.62 |
| 92551 |
|
77 |
61 |
$522.45 |
| 0001A |
|
18 |
13 |
$440.00 |
| 81025 |
|
90 |
74 |
$401.36 |
| 90651 |
|
108 |
104 |
$369.70 |
| 99401 |
|
15 |
14 |
$368.13 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
57 |
47 |
$342.85 |
| 99173 |
|
119 |
99 |
$307.89 |
| 90716 |
|
150 |
132 |
$230.34 |
| 90707 |
|
149 |
132 |
$128.06 |
| 90734 |
|
123 |
114 |
$107.91 |
| 36415 |
Collection of venous blood by venipuncture |
66 |
49 |
$97.57 |
| 90633 |
|
79 |
69 |
$59.26 |
| 90461 |
|
1,175 |
1,092 |
$22.52 |
| 90686 |
|
25 |
21 |
$0.00 |
| 90670 |
|
29 |
26 |
$0.00 |
| 90658 |
|
44 |
44 |
$0.00 |