| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99381 |
|
562 |
537 |
$44K |
| 99401 |
|
1,284 |
1,161 |
$36K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
760 |
723 |
$7K |
| 81025 |
|
1,191 |
1,072 |
$6K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
123 |
117 |
$5K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
127 |
115 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
108 |
97 |
$2K |
| 99402 |
|
35 |
32 |
$2K |
| D1206 |
Topical application of fluoride varnish |
54 |
54 |
$1K |
| 0001A |
|
24 |
18 |
$806.64 |
| 0002A |
|
26 |
17 |
$795.52 |
| D0190 |
|
54 |
54 |
$636.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
28 |
26 |
$467.92 |
| 99071 |
|
115 |
103 |
$430.00 |
| 36415 |
Collection of venous blood by venipuncture |
202 |
194 |
$389.70 |
| 92551 |
|
17 |
16 |
$120.12 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$99.06 |
| 96127 |
|
16 |
16 |
$66.61 |
| 99173 |
|
14 |
14 |
$47.65 |
| 90461 |
|
33 |
32 |
$0.00 |
| 91300 |
|
13 |
12 |
$0.00 |