| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
652 |
641 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
688 |
661 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,705 |
1,612 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
150 |
146 |
$2K |
| 85018 |
|
505 |
505 |
$989.53 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
190 |
190 |
$869.52 |
| 99173 |
|
276 |
274 |
$868.26 |
| 92551 |
|
276 |
274 |
$602.11 |
| 81003 |
|
314 |
313 |
$597.31 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
366 |
364 |
$407.59 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
49 |
47 |
$307.56 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$305.82 |
| 90686 |
|
49 |
48 |
$232.00 |
| 90633 |
|
145 |
145 |
$108.00 |
| 90670 |
|
218 |
213 |
$90.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
36 |
36 |
$54.83 |
| 90680 |
|
72 |
72 |
$45.00 |
| 90698 |
|
114 |
113 |
$42.75 |
| 90710 |
|
30 |
30 |
$36.00 |
| 90696 |
|
30 |
30 |
$36.00 |
| 90656 |
|
14 |
14 |
$36.00 |
| 90700 |
|
49 |
49 |
$27.00 |
| 90688 |
|
12 |
12 |
$27.00 |
| 90685 |
|
13 |
13 |
$18.00 |
| 90744 |
|
28 |
28 |
$9.00 |
| 90651 |
|
50 |
50 |
$9.00 |
| 90734 |
|
16 |
16 |
$0.00 |
| 90715 |
|
14 |
14 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
20 |
16 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |