| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,893 |
781 |
$46K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
410 |
366 |
$31K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
306 |
285 |
$16K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
196 |
153 |
$13K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,585 |
1,208 |
$10K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
57 |
56 |
$4K |
| 96160 |
|
1,103 |
943 |
$2K |
| 88738 |
|
618 |
523 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$240.00 |
| 92551 |
|
27 |
25 |
$232.00 |
| 3008F |
|
1,068 |
927 |
$170.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
16 |
16 |
$95.55 |
| 90461 |
|
121 |
79 |
$90.08 |
| 99177 |
|
14 |
12 |
$31.92 |
| 96161 |
|
13 |
12 |
$18.48 |
| 90670 |
|
90 |
71 |
$0.00 |
| 90672 |
|
35 |
25 |
$0.00 |
| 36416 |
|
31 |
30 |
$0.00 |
| 90723 |
|
36 |
25 |
$0.00 |
| 90686 |
|
17 |
17 |
$0.00 |
| 99000 |
|
13 |
13 |
$0.00 |