| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,666 |
1,583 |
$58K |
| 99402 |
|
449 |
412 |
$22K |
| 81025 |
|
634 |
565 |
$3K |
| 99401 |
|
84 |
77 |
$2K |
| 0001A |
|
52 |
50 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
146 |
135 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
23 |
16 |
$1K |
| D1206 |
Topical application of fluoride varnish |
136 |
136 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
16 |
14 |
$1K |
| 92551 |
|
142 |
118 |
$998.02 |
| 0002A |
|
20 |
19 |
$774.44 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
26 |
25 |
$715.88 |
| D0190 |
|
137 |
137 |
$660.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
48 |
44 |
$656.07 |
| 90651 |
|
123 |
118 |
$554.55 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
54 |
52 |
$529.82 |
| 83655 |
|
49 |
36 |
$492.41 |
| 0011A |
|
14 |
13 |
$440.00 |
| 99177 |
|
67 |
54 |
$355.56 |
| 85018 |
|
159 |
128 |
$331.63 |
| 90715 |
|
220 |
214 |
$257.71 |
| 96127 |
|
68 |
53 |
$241.61 |
| 90686 |
|
563 |
555 |
$240.00 |
| 36416 |
|
173 |
141 |
$234.07 |
| 90734 |
|
132 |
127 |
$215.82 |
| 90670 |
|
17 |
12 |
$160.66 |
| 90707 |
|
81 |
73 |
$64.03 |
| 90688 |
|
17 |
17 |
$60.00 |
| 99173 |
|
25 |
17 |
$51.20 |
| 90461 |
|
603 |
572 |
$45.04 |
| 90716 |
|
64 |
57 |
$0.00 |
| 90647 |
|
15 |
15 |
$0.00 |
| 90696 |
|
30 |
28 |
$0.00 |
| 90674 |
|
125 |
124 |
$0.00 |
| 90633 |
|
67 |
60 |
$0.00 |
| 91300 |
|
13 |
13 |
$0.00 |