| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,195 |
3,013 |
$124K |
| 90461 |
|
1,619 |
1,532 |
$106K |
| D1206 |
Topical application of fluoride varnish |
177 |
173 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
130 |
125 |
$3K |
| 0012A |
|
79 |
78 |
$2K |
| 99201 |
|
55 |
53 |
$2K |
| 90686 |
|
397 |
388 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
48 |
42 |
$2K |
| 0011A |
|
83 |
80 |
$2K |
| 90682 |
|
36 |
36 |
$2K |
| 90651 |
|
288 |
269 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 0002A |
|
27 |
27 |
$1K |
| 83655 |
|
62 |
60 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
18 |
17 |
$1K |
| 99383 |
|
13 |
12 |
$955.80 |
| 0071A |
|
24 |
24 |
$840.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
45 |
42 |
$804.32 |
| 90633 |
|
729 |
718 |
$759.10 |
| 0072A |
|
20 |
20 |
$720.00 |
| 92551 |
|
64 |
60 |
$617.14 |
| 0001A |
|
15 |
15 |
$600.00 |
| 90734 |
|
203 |
200 |
$528.80 |
| 90670 |
|
467 |
462 |
$448.20 |
| 85018 |
|
186 |
165 |
$378.20 |
| 90647 |
|
211 |
210 |
$260.90 |
| 90715 |
|
163 |
153 |
$219.64 |
| 90723 |
|
134 |
133 |
$202.40 |
| 99173 |
|
80 |
76 |
$191.52 |
| 90656 |
|
20 |
16 |
$118.30 |
| 36416 |
|
71 |
66 |
$108.00 |
| 90619 |
|
199 |
163 |
$82.00 |
| 90681 |
|
24 |
24 |
$36.80 |
| 0003A |
|
22 |
22 |
$0.00 |
| 90710 |
|
13 |
13 |
$0.00 |
| 91301 |
|
31 |
30 |
$0.00 |