| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
830 |
798 |
$31K |
| 99401 |
|
588 |
531 |
$16K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
31 |
28 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
130 |
115 |
$2K |
| D1206 |
Topical application of fluoride varnish |
85 |
85 |
$2K |
| 81025 |
|
322 |
295 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
89 |
82 |
$963.22 |
| D0190 |
|
84 |
84 |
$924.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$587.32 |
| 90651 |
|
74 |
71 |
$554.55 |
| 99177 |
|
83 |
74 |
$550.84 |
| 94250 |
|
24 |
24 |
$502.04 |
| 0001A |
|
13 |
12 |
$440.00 |
| 90688 |
|
213 |
210 |
$290.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
30 |
29 |
$225.45 |
| 96127 |
|
54 |
50 |
$213.79 |
| 92551 |
|
27 |
23 |
$203.20 |
| 36415 |
Collection of venous blood by venipuncture |
117 |
100 |
$193.95 |
| 90686 |
|
18 |
18 |
$105.00 |
| 85018 |
|
17 |
17 |
$50.83 |
| 36416 |
|
18 |
18 |
$46.90 |
| 90715 |
|
54 |
51 |
$35.80 |
| 90619 |
|
14 |
14 |
$0.00 |
| 90461 |
|
137 |
135 |
$0.00 |
| 90734 |
|
51 |
50 |
$0.00 |