| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,760 |
1,720 |
$72K |
| 90461 |
|
526 |
513 |
$33K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
458 |
419 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,211 |
1,151 |
$21K |
| 99201 |
|
388 |
385 |
$15K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
231 |
218 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
87 |
60 |
$6K |
| 0012A |
|
69 |
67 |
$2K |
| 0001A |
|
50 |
46 |
$2K |
| 90651 |
|
165 |
161 |
$1K |
| 0002A |
|
41 |
38 |
$1K |
| 92551 |
|
134 |
130 |
$1K |
| 0011A |
|
78 |
77 |
$1K |
| 99383 |
|
13 |
12 |
$1K |
| 99173 |
|
484 |
477 |
$1K |
| 90688 |
|
251 |
247 |
$895.67 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
29 |
29 |
$655.69 |
| 0031A |
|
18 |
16 |
$600.00 |
| 90734 |
|
107 |
105 |
$584.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
12 |
12 |
$552.97 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
12 |
12 |
$552.97 |
| 0064A |
|
18 |
12 |
$440.00 |
| 90633 |
|
248 |
243 |
$404.80 |
| 90715 |
|
38 |
38 |
$165.60 |
| 90620 |
|
89 |
88 |
$55.20 |
| 81025 |
|
13 |
13 |
$20.64 |
| 91301 |
|
148 |
145 |
$0.00 |