| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,980 |
3,883 |
$172K |
| 90461 |
|
1,714 |
1,663 |
$113K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,588 |
1,414 |
$60K |
| 99201 |
|
433 |
416 |
$16K |
| D1206 |
Topical application of fluoride varnish |
877 |
853 |
$16K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
342 |
313 |
$16K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
329 |
301 |
$15K |
| 83655 |
|
677 |
656 |
$11K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
300 |
281 |
$6K |
| 90686 |
|
1,034 |
1,012 |
$6K |
| S4993 |
Contraceptive pills for birth control |
257 |
237 |
$5K |
| 97802 |
|
74 |
68 |
$4K |
| 90651 |
|
716 |
703 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
46 |
45 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
32 |
31 |
$3K |
| 90633 |
|
1,212 |
1,195 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
26 |
25 |
$2K |
| 90734 |
|
484 |
469 |
$2K |
| 92551 |
|
133 |
132 |
$1K |
| 0031A |
|
70 |
63 |
$1K |
| 90715 |
|
336 |
325 |
$1K |
| 0012A |
|
44 |
44 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
13 |
13 |
$896.87 |
| 99173 |
|
332 |
325 |
$685.97 |
| 90670 |
|
487 |
470 |
$680.80 |
| 0064A |
|
26 |
15 |
$600.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
14 |
13 |
$565.44 |
| 0011A |
|
48 |
46 |
$520.44 |
| 0001A |
|
16 |
13 |
$520.00 |
| 90723 |
|
288 |
281 |
$441.60 |
| 90647 |
|
340 |
329 |
$386.40 |
| 90680 |
|
158 |
157 |
$239.20 |
| 90710 |
|
166 |
162 |
$165.60 |
| 90696 |
|
129 |
127 |
$128.80 |
| 90700 |
|
25 |
25 |
$110.40 |
| 90620 |
|
43 |
43 |
$110.40 |
| 90656 |
|
12 |
12 |
$103.85 |
| 90716 |
|
14 |
14 |
$73.60 |
| 81025 |
|
42 |
37 |
$65.63 |
| 85018 |
|
27 |
26 |
$64.05 |
| 90685 |
|
56 |
55 |
$55.20 |
| 90707 |
|
28 |
26 |
$55.20 |
| 91301 |
|
112 |
107 |
$0.01 |
| 91303 |
|
61 |
56 |
$0.01 |
| 90671 |
|
14 |
14 |
$0.00 |
| 90619 |
|
224 |
219 |
$0.00 |
| 90688 |
|
21 |
21 |
$0.00 |