| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,702 |
3,648 |
$145K |
| 90461 |
|
1,481 |
1,462 |
$87K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
334 |
324 |
$13K |
| D1206 |
Topical application of fluoride varnish |
428 |
420 |
$8K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
116 |
116 |
$8K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
83 |
82 |
$4K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
83 |
82 |
$4K |
| 90688 |
|
308 |
304 |
$3K |
| 90734 |
|
467 |
463 |
$1K |
| 90633 |
|
1,339 |
1,326 |
$1K |
| 86580 |
|
178 |
175 |
$1K |
| 90651 |
|
434 |
430 |
$1K |
| 90670 |
|
664 |
658 |
$797.80 |
| 90648 |
|
606 |
597 |
$767.60 |
| 90686 |
|
264 |
262 |
$651.40 |
| 90723 |
|
431 |
425 |
$540.20 |
| S4993 |
Contraceptive pills for birth control |
24 |
24 |
$488.58 |
| 90680 |
|
318 |
314 |
$478.40 |
| 99201 |
|
12 |
12 |
$478.32 |
| 90656 |
|
33 |
33 |
$468.00 |
| 83655 |
|
27 |
27 |
$433.50 |
| 90707 |
|
389 |
384 |
$426.50 |
| 90716 |
|
418 |
413 |
$426.50 |
| 92551 |
|
26 |
26 |
$271.96 |
| 90700 |
|
116 |
114 |
$147.20 |
| 90715 |
|
104 |
103 |
$146.04 |
| 90685 |
|
120 |
112 |
$110.40 |
| 90696 |
|
46 |
45 |
$73.60 |
| A4267 |
Contraceptive supply, condom, male, each |
12 |
12 |
$28.25 |
| 90687 |
|
37 |
37 |
$0.00 |