| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
61,266 |
47,610 |
$9.08M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,836 |
2,690 |
$340K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,194 |
1,732 |
$200K |
| D1351 |
Sealant - per tooth |
7,009 |
2,045 |
$168K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
982 |
917 |
$159K |
| D1206 |
Topical application of fluoride varnish |
5,518 |
5,481 |
$95K |
| D0191 |
|
5,951 |
5,913 |
$48K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
240 |
225 |
$32K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
246 |
238 |
$26K |
| 99443 |
|
1,075 |
950 |
$25K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,608 |
1,542 |
$23K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
15 |
15 |
$15K |
| D0190 |
|
1,372 |
1,360 |
$5K |
| 59430 |
|
39 |
39 |
$5K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
27 |
26 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
16 |
16 |
$3K |
| D1330 |
|
3,360 |
3,332 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
87 |
56 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
627 |
574 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
327 |
312 |
$984.00 |
| 99442 |
|
29 |
27 |
$449.24 |
| 90686 |
|
123 |
104 |
$400.01 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
59 |
54 |
$250.50 |
| 90633 |
|
32 |
26 |
$132.00 |
| 90670 |
|
26 |
24 |
$44.00 |
| 90715 |
|
13 |
12 |
$33.00 |
| 90461 |
|
26 |
24 |
$0.00 |
| 11981 |
|
13 |
13 |
$0.00 |
| 97802 |
|
71 |
69 |
$0.00 |
| 2010F |
|
541 |
39 |
$0.00 |
| D1353 |
|
56 |
36 |
$0.00 |