| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
964 |
939 |
$30K |
| 99401 |
|
949 |
862 |
$27K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
343 |
341 |
$25K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
878 |
847 |
$10K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
108 |
105 |
$7K |
| 94250 |
|
306 |
257 |
$6K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
170 |
146 |
$5K |
| 92551 |
|
176 |
161 |
$1K |
| 81025 |
|
189 |
175 |
$1K |
| 99381 |
|
16 |
15 |
$980.16 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$975.87 |
| 36416 |
|
306 |
295 |
$667.59 |
| 99071 |
|
242 |
210 |
$636.74 |
| 83655 |
|
44 |
42 |
$511.35 |
| 90686 |
|
526 |
521 |
$265.00 |
| 99177 |
|
26 |
25 |
$146.45 |
| 96127 |
|
35 |
31 |
$137.93 |
| 99173 |
|
45 |
39 |
$124.24 |
| 90716 |
|
63 |
62 |
$115.17 |
| 85018 |
|
28 |
28 |
$72.26 |
| 90707 |
|
50 |
49 |
$64.03 |
| 99070 |
|
57 |
47 |
$0.00 |
| 90696 |
|
17 |
17 |
$0.00 |
| 90461 |
|
203 |
194 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| 90670 |
|
17 |
17 |
$0.00 |