| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,714 |
1,603 |
$76K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
200 |
189 |
$13K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
823 |
762 |
$8K |
| 99401 |
|
303 |
238 |
$8K |
| D1206 |
Topical application of fluoride varnish |
446 |
421 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
86 |
83 |
$6K |
| D0190 |
|
446 |
421 |
$4K |
| 99381 |
|
50 |
39 |
$3K |
| 0001A |
|
60 |
52 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
46 |
39 |
$1K |
| 0011A |
|
42 |
30 |
$1K |
| 0002A |
|
27 |
25 |
$920.00 |
| 90688 |
|
285 |
267 |
$670.20 |
| 90677 |
|
126 |
118 |
$470.44 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
46 |
39 |
$346.36 |
| 36415 |
Collection of venous blood by venipuncture |
192 |
169 |
$315.76 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$281.40 |
| 81025 |
|
63 |
48 |
$277.75 |
| 90707 |
|
130 |
123 |
$256.12 |
| 90671 |
|
26 |
26 |
$202.03 |
| 90651 |
|
16 |
16 |
$184.85 |
| 92551 |
|
24 |
12 |
$172.27 |
| 96127 |
|
41 |
24 |
$118.09 |
| 90686 |
|
31 |
26 |
$105.00 |
| 90716 |
|
126 |
118 |
$65.33 |
| 90715 |
|
24 |
24 |
$37.61 |
| 90633 |
|
132 |
127 |
$29.63 |
| 90461 |
|
987 |
933 |
$22.52 |
| 90700 |
|
26 |
26 |
$22.38 |
| 91301 |
|
21 |
15 |
$0.00 |
| 90697 |
|
15 |
15 |
$0.00 |
| 90670 |
|
93 |
89 |
$0.00 |