| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,421 |
1,307 |
$53K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
145 |
126 |
$10K |
| D1206 |
Topical application of fluoride varnish |
490 |
484 |
$8K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
880 |
794 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
117 |
109 |
$8K |
| D0190 |
|
490 |
484 |
$5K |
| 99401 |
|
105 |
73 |
$3K |
| 90688 |
|
644 |
584 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
232 |
190 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
43 |
38 |
$2K |
| 0011A |
|
51 |
35 |
$1K |
| 0001A |
|
36 |
27 |
$1K |
| 99381 |
|
17 |
12 |
$1K |
| 0002A |
|
23 |
14 |
$689.96 |
| 90715 |
|
81 |
77 |
$512.23 |
| 0012A |
|
18 |
14 |
$472.20 |
| 90734 |
|
30 |
29 |
$342.49 |
| 90651 |
|
28 |
27 |
$184.85 |
| 92551 |
|
27 |
26 |
$184.82 |
| 90461 |
|
530 |
482 |
$101.34 |
| 90686 |
|
92 |
88 |
$90.00 |
| 96127 |
|
14 |
13 |
$57.73 |
| 99173 |
|
15 |
14 |
$43.86 |
| 36415 |
Collection of venous blood by venipuncture |
30 |
25 |
$39.83 |
| 90670 |
|
25 |
24 |
$0.00 |
| 91301 |
|
13 |
12 |
$0.00 |