| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,471 |
1,423 |
$48K |
| 90461 |
|
662 |
627 |
$38K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
664 |
573 |
$24K |
| 90632 |
|
75 |
75 |
$4K |
| 0012A |
|
138 |
135 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
114 |
111 |
$2K |
| D1206 |
Topical application of fluoride varnish |
115 |
115 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
117 |
95 |
$2K |
| 86580 |
|
286 |
240 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
27 |
27 |
$2K |
| 0031A |
|
75 |
75 |
$2K |
| 0011A |
|
108 |
107 |
$1K |
| 90688 |
|
70 |
65 |
$694.20 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$679.30 |
| 97802 |
|
16 |
16 |
$626.26 |
| 99442 |
|
30 |
30 |
$554.10 |
| 90633 |
|
957 |
938 |
$541.60 |
| 0013A |
|
12 |
12 |
$400.00 |
| 0064A |
|
14 |
14 |
$360.00 |
| 90670 |
|
71 |
70 |
$147.20 |
| 90647 |
|
29 |
28 |
$110.40 |
| 90734 |
|
168 |
167 |
$110.40 |
| 90723 |
|
24 |
24 |
$92.00 |
| 81025 |
|
41 |
39 |
$56.76 |
| 90710 |
|
24 |
24 |
$55.20 |
| 90715 |
|
47 |
47 |
$55.20 |
| 91301 |
|
336 |
313 |
$0.00 |
| 91303 |
|
53 |
53 |
$0.00 |
| 90619 |
|
15 |
15 |
$0.00 |