| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,459 |
1,371 |
$46K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
854 |
655 |
$30K |
| 99401 |
|
752 |
606 |
$19K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
218 |
205 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
474 |
413 |
$13K |
| D1206 |
Topical application of fluoride varnish |
693 |
689 |
$12K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
909 |
824 |
$8K |
| D0190 |
|
690 |
685 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
107 |
106 |
$7K |
| 0001A |
|
101 |
79 |
$3K |
| 90688 |
|
700 |
663 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
17 |
16 |
$1K |
| 0002A |
|
35 |
32 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
748 |
644 |
$1K |
| 96127 |
|
271 |
169 |
$1K |
| 92551 |
|
107 |
96 |
$782.36 |
| 90651 |
|
38 |
32 |
$725.10 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
122 |
97 |
$724.46 |
| 99173 |
|
131 |
116 |
$354.49 |
| 90715 |
|
129 |
114 |
$338.49 |
| 81025 |
|
60 |
54 |
$310.62 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$292.80 |
| 90686 |
|
69 |
65 |
$210.00 |
| 90716 |
|
20 |
18 |
$115.17 |
| 90461 |
|
405 |
364 |
$90.08 |
| 36416 |
|
61 |
53 |
$71.81 |
| 90707 |
|
20 |
18 |
$64.03 |
| 90734 |
|
24 |
22 |
$0.00 |
| 91300 |
|
18 |
18 |
$0.00 |
| 90633 |
|
14 |
13 |
$0.00 |