| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
434 |
364 |
$13K |
| D0190 |
|
525 |
477 |
$9K |
| D1206 |
Topical application of fluoride varnish |
424 |
383 |
$7K |
| 99402 |
|
131 |
101 |
$5K |
| 99401 |
|
52 |
52 |
$2K |
| D1351 |
Sealant - per tooth |
39 |
13 |
$1K |
| 0012A |
|
58 |
56 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
30 |
30 |
$381.60 |
| 90688 |
|
60 |
39 |
$331.59 |
| 0011A |
|
16 |
13 |
$233.43 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
45 |
24 |
$201.93 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
30 |
30 |
$12.74 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
41 |
41 |
$0.00 |
| 90715 |
|
36 |
35 |
$0.00 |
| 90686 |
|
91 |
63 |
$0.00 |
| 99000 |
|
41 |
41 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
41 |
41 |
$0.00 |
| 90651 |
|
13 |
13 |
$0.00 |
| 91301 |
|
107 |
96 |
$0.00 |
| 90656 |
|
41 |
35 |
$0.00 |