| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
8,084 |
7,255 |
$1.26M |
| 99199 |
Unlisted special service, procedure or report |
1,975 |
1,975 |
$11K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
737 |
362 |
$9K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
274 |
243 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
102 |
92 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
400 |
351 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
96 |
87 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
140 |
126 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
47 |
41 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
211 |
208 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
94 |
90 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
259 |
241 |
$2K |
| D1206 |
Topical application of fluoride varnish |
94 |
90 |
$1K |
| 90474 |
|
15 |
13 |
$259.11 |
| 87807 |
|
14 |
13 |
$185.57 |
| 80305 |
|
15 |
13 |
$163.32 |
| 90686 |
|
93 |
83 |
$66.20 |
| 92551 |
|
282 |
244 |
$27.02 |
| 99173 |
|
301 |
263 |
$18.00 |
| 90696 |
|
12 |
12 |
$0.00 |
| 90680 |
|
14 |
12 |
$0.00 |
| 90670 |
|
107 |
100 |
$0.00 |
| 90633 |
|
14 |
13 |
$0.00 |
| 90710 |
|
14 |
14 |
$0.00 |