| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,742 |
2,499 |
$82K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
617 |
614 |
$35K |
| 90461 |
|
512 |
511 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,000 |
983 |
$18K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
674 |
608 |
$14K |
| 90686 |
|
995 |
989 |
$8K |
| 90632 |
|
106 |
106 |
$6K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
100 |
98 |
$6K |
| 99173 |
|
1,347 |
1,339 |
$3K |
| 0013A |
|
104 |
104 |
$3K |
| 85018 |
|
874 |
872 |
$3K |
| 0002A |
|
69 |
68 |
$2K |
| 0001A |
|
70 |
70 |
$2K |
| 92551 |
|
190 |
190 |
$2K |
| 0012A |
|
40 |
40 |
$1K |
| 99381 |
|
14 |
14 |
$1K |
| 90651 |
|
350 |
348 |
$1K |
| 0011A |
|
26 |
26 |
$960.00 |
| 90688 |
|
137 |
136 |
$672.80 |
| 90633 |
|
647 |
645 |
$653.90 |
| 0003A |
|
13 |
13 |
$480.00 |
| 99383 |
|
12 |
12 |
$477.90 |
| 90619 |
|
26 |
26 |
$374.86 |
| 90734 |
|
277 |
276 |
$329.60 |
| 90656 |
|
30 |
30 |
$294.40 |
| 90715 |
|
101 |
100 |
$285.96 |
| 0134A |
|
15 |
12 |
$200.00 |
| 82962 |
|
40 |
40 |
$134.00 |
| 90685 |
|
52 |
52 |
$36.80 |
| 90710 |
|
12 |
12 |
$18.40 |
| 90696 |
|
13 |
13 |
$18.40 |
| 81002 |
|
16 |
16 |
$17.25 |
| 90670 |
|
13 |
12 |
$0.00 |
| 90662 |
|
16 |
16 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
17 |
17 |
$0.00 |