| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,506 |
2,272 |
$408K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,204 |
1,195 |
$52K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
254 |
243 |
$42K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
153 |
153 |
$26K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
121 |
121 |
$20K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
110 |
110 |
$18K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,524 |
1,501 |
$16K |
| 99173 |
|
653 |
653 |
$15K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
1,583 |
1,556 |
$14K |
| 92551 |
|
724 |
724 |
$7K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
106 |
105 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
98 |
97 |
$1K |
| 99188 |
|
26 |
26 |
$676.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
12 |
12 |
$615.72 |
| 90651 |
|
42 |
41 |
$408.22 |
| 81002 |
|
146 |
146 |
$375.22 |
| 90686 |
|
498 |
497 |
$238.06 |
| 96127 |
|
19 |
19 |
$195.13 |
| 85018 |
|
70 |
70 |
$155.52 |
| 90734 |
|
53 |
52 |
$97.15 |
| 90670 |
|
148 |
148 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |