| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,153 |
4,076 |
$80K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
466 |
458 |
$36K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,310 |
6,540 |
$11K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
757 |
733 |
$10K |
| G9920 |
Screening performed and negative |
343 |
343 |
$10K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,745 |
1,723 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,262 |
1,187 |
$8K |
| 99173 |
|
2,161 |
2,126 |
$7K |
| 81002 |
|
2,469 |
2,430 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
827 |
822 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
479 |
479 |
$1K |
| 96127 |
|
217 |
217 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
452 |
451 |
$870.00 |
| 97802 |
|
12 |
12 |
$364.20 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$288.00 |
| 92552 |
|
13 |
13 |
$15.30 |
| 92551 |
|
72 |
71 |
$0.00 |
| 99384 |
|
14 |
14 |
$0.00 |
| 99383 |
|
13 |
13 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
60 |
60 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$0.00 |