| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
933 |
859 |
$41K |
| 99401 |
|
737 |
646 |
$20K |
| D1206 |
Topical application of fluoride varnish |
963 |
961 |
$16K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,091 |
972 |
$16K |
| D0190 |
|
963 |
961 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
145 |
125 |
$5K |
| 81025 |
|
1,031 |
910 |
$5K |
| 90651 |
|
201 |
183 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
32 |
27 |
$2K |
| 99402 |
|
33 |
31 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
181 |
169 |
$1K |
| 90619 |
|
115 |
107 |
$1K |
| 0011A |
|
26 |
21 |
$708.88 |
| 0012A |
|
19 |
16 |
$683.32 |
| 90715 |
|
196 |
187 |
$564.15 |
| 0002A |
|
16 |
12 |
$497.76 |
| 36415 |
Collection of venous blood by venipuncture |
265 |
229 |
$495.11 |
| 0001A |
|
17 |
16 |
$494.44 |
| 90686 |
|
76 |
63 |
$270.00 |
| 85018 |
|
78 |
70 |
$136.65 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
13 |
$126.65 |
| 90716 |
|
36 |
35 |
$115.17 |
| 90734 |
|
61 |
57 |
$107.91 |
| 36416 |
|
93 |
85 |
$85.81 |
| 90656 |
|
15 |
15 |
$24.37 |
| 90696 |
|
13 |
13 |
$0.00 |
| 90633 |
|
31 |
30 |
$0.00 |
| 90461 |
|
450 |
423 |
$0.00 |
| 90707 |
|
34 |
33 |
$0.00 |
| 91300 |
|
13 |
13 |
$0.00 |