| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
301 |
301 |
$9K |
| 90461 |
|
66 |
66 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
39 |
39 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
26 |
26 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
40 |
39 |
$655.20 |
| 96127 |
|
78 |
78 |
$40.00 |
| 81003 |
|
13 |
13 |
$28.93 |
| 90686 |
|
62 |
62 |
$0.00 |
| 99173 |
|
31 |
31 |
$0.00 |