| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1017 |
Targeted case management, each 15 minutes |
480 |
271 |
$119K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,921 |
4,741 |
$85K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,215 |
2,120 |
$41K |
| D0191 |
|
3,408 |
3,406 |
$37K |
| D1351 |
Sealant - per tooth |
1,890 |
426 |
$28K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,175 |
1,134 |
$21K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
584 |
567 |
$15K |
| 91320 |
|
105 |
105 |
$9K |
| 90686 |
|
1,334 |
1,333 |
$6K |
| 90480 |
|
147 |
147 |
$5K |
| 90651 |
|
489 |
474 |
$4K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
116 |
99 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
160 |
156 |
$3K |
| 81025 |
|
289 |
263 |
$2K |
| 90715 |
|
525 |
510 |
$2K |
| 90734 |
|
507 |
499 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
30 |
30 |
$1K |
| 90620 |
|
78 |
78 |
$1K |
| D1120 |
Prophylaxis - child |
14 |
14 |
$768.79 |
| 90656 |
|
96 |
95 |
$607.27 |
| S4993 |
Contraceptive pills for birth control |
25 |
24 |
$330.50 |
| D1206 |
Topical application of fluoride varnish |
3,269 |
3,267 |
$76.03 |
| 36415 |
Collection of venous blood by venipuncture |
14 |
14 |
$32.40 |
| 90633 |
|
106 |
96 |
$7.84 |
| 90710 |
|
92 |
91 |
$0.00 |
| 90685 |
|
13 |
13 |
$0.00 |
| 90670 |
|
149 |
133 |
$0.00 |
| 90723 |
|
24 |
24 |
$0.00 |
| 90619 |
|
99 |
99 |
$0.00 |
| 90696 |
|
75 |
73 |
$0.00 |
| 90647 |
|
15 |
14 |
$0.00 |