| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,120 |
1,071 |
$45K |
| 90461 |
|
327 |
316 |
$19K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
391 |
361 |
$14K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
93 |
55 |
$1K |
| 99201 |
|
37 |
37 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
65 |
54 |
$1K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
27 |
25 |
$1K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
27 |
25 |
$1K |
| 90686 |
|
201 |
165 |
$984.36 |
| 0012A |
|
22 |
21 |
$760.00 |
| 0001A |
|
12 |
12 |
$480.00 |
| 0002A |
|
12 |
12 |
$440.00 |
| 0011A |
|
13 |
12 |
$400.00 |
| 0064A |
|
15 |
13 |
$360.00 |
| 90633 |
|
119 |
118 |
$92.00 |
| 90734 |
|
50 |
49 |
$82.00 |
| 90670 |
|
45 |
42 |
$55.20 |
| 90723 |
|
13 |
12 |
$36.80 |
| 90647 |
|
14 |
13 |
$18.40 |
| 90715 |
|
12 |
12 |
$18.40 |
| 90651 |
|
39 |
39 |
$0.00 |