| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,709 |
1,607 |
$61K |
| 99401 |
|
504 |
445 |
$14K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
178 |
165 |
$11K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
764 |
715 |
$7K |
| 99381 |
|
72 |
69 |
$5K |
| 81025 |
|
961 |
880 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
123 |
108 |
$3K |
| 83655 |
|
268 |
240 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
43 |
41 |
$3K |
| 99402 |
|
26 |
26 |
$1K |
| 90715 |
|
427 |
410 |
$1K |
| 0001A |
|
21 |
21 |
$760.00 |
| 92551 |
|
104 |
94 |
$637.46 |
| 90686 |
|
446 |
426 |
$615.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
59 |
59 |
$548.29 |
| 90734 |
|
104 |
99 |
$539.55 |
| 36416 |
|
323 |
290 |
$503.10 |
| 85018 |
|
216 |
185 |
$432.49 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$422.17 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
25 |
24 |
$388.18 |
| 90651 |
|
149 |
142 |
$369.70 |
| 90716 |
|
78 |
68 |
$345.51 |
| 36415 |
Collection of venous blood by venipuncture |
170 |
155 |
$280.60 |
| 99177 |
|
33 |
32 |
$262.13 |
| D1206 |
Topical application of fluoride varnish |
27 |
26 |
$246.00 |
| 96127 |
|
53 |
49 |
$206.77 |
| 99173 |
|
67 |
60 |
$160.25 |
| D0190 |
|
27 |
26 |
$144.00 |
| 90619 |
|
32 |
28 |
$129.43 |
| 90707 |
|
83 |
76 |
$128.06 |
| 90688 |
|
19 |
18 |
$100.00 |
| 90656 |
|
70 |
70 |
$0.00 |
| 90674 |
|
92 |
91 |
$0.00 |
| 90696 |
|
40 |
38 |
$0.00 |
| 90647 |
|
19 |
12 |
$0.00 |
| 90461 |
|
705 |
668 |
$0.00 |
| 90633 |
|
62 |
56 |
$0.00 |
| 90661 |
|
38 |
38 |
$0.00 |