| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,779 |
1,722 |
$64K |
| 99401 |
|
842 |
795 |
$25K |
| D1206 |
Topical application of fluoride varnish |
919 |
918 |
$17K |
| D0190 |
|
919 |
918 |
$10K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
647 |
595 |
$10K |
| 81025 |
|
906 |
829 |
$4K |
| 99402 |
|
71 |
64 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
85 |
81 |
$907.81 |
| 0001A |
|
25 |
21 |
$857.76 |
| 90686 |
|
616 |
599 |
$795.00 |
| 0002A |
|
19 |
15 |
$617.76 |
| 90716 |
|
23 |
20 |
$295.67 |
| 96127 |
|
49 |
48 |
$196.68 |
| 90715 |
|
41 |
38 |
$187.20 |
| 90651 |
|
13 |
12 |
$184.85 |
| 36415 |
Collection of venous blood by venipuncture |
79 |
75 |
$151.97 |
| 90707 |
|
33 |
30 |
$128.06 |
| 90688 |
|
12 |
12 |
$100.00 |
| 90461 |
|
665 |
646 |
$90.08 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
14 |
14 |
$84.65 |
| 99173 |
|
13 |
13 |
$32.94 |
| 90674 |
|
59 |
59 |
$0.00 |
| 99000 |
|
12 |
12 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |
| 90633 |
|
48 |
45 |
$0.00 |
| 90710 |
|
15 |
15 |
$0.00 |