| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
9,077 |
8,356 |
$153K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
5,459 |
4,974 |
$115K |
| 90707 |
|
1,147 |
1,050 |
$76K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,875 |
1,852 |
$68K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,876 |
1,851 |
$68K |
| 90716 |
|
526 |
472 |
$53K |
| 90715 |
|
1,248 |
1,152 |
$37K |
| 90746 |
|
599 |
584 |
$26K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
136 |
133 |
$15K |
| 91322 |
|
155 |
118 |
$15K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
85 |
83 |
$15K |
| 99385 |
|
145 |
124 |
$13K |
| 90686 |
|
1,790 |
1,691 |
$12K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
696 |
547 |
$12K |
| 99401 |
|
430 |
337 |
$12K |
| 90480 |
|
495 |
435 |
$11K |
| 90651 |
|
179 |
168 |
$8K |
| 90713 |
|
303 |
238 |
$6K |
| 90714 |
|
166 |
161 |
$5K |
| 86480 |
|
55 |
52 |
$4K |
| 90688 |
|
254 |
219 |
$4K |
| 81025 |
|
550 |
451 |
$4K |
| 86592 |
|
1,062 |
852 |
$3K |
| 91320 |
|
32 |
32 |
$3K |
| 90670 |
|
240 |
219 |
$3K |
| 90734 |
|
94 |
93 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
46 |
27 |
$3K |
| 90656 |
|
142 |
142 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
16 |
13 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27 |
17 |
$886.80 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
15 |
$717.30 |
| 90674 |
|
163 |
159 |
$466.44 |
| 90658 |
|
30 |
29 |
$453.56 |
| 87210 |
|
55 |
52 |
$250.02 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
12 |
12 |
$120.08 |
| 90633 |
|
223 |
215 |
$115.62 |
| S4993 |
Contraceptive pills for birth control |
12 |
12 |
$80.51 |
| 90710 |
|
75 |
72 |
$0.00 |
| 90685 |
|
65 |
64 |
$0.00 |
| 0121A |
|
27 |
27 |
$0.00 |
| 91300 |
|
35 |
33 |
$0.00 |
| 91312 |
|
73 |
72 |
$0.00 |
| Q2035 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) |
116 |
116 |
$0.00 |
| 90743 |
|
14 |
14 |
$0.00 |
| 90696 |
|
24 |
22 |
$0.00 |
| 0011A |
|
14 |
13 |
$0.00 |
| 90723 |
|
32 |
29 |
$0.00 |
| 90647 |
|
42 |
38 |
$0.00 |
| 0001A |
|
33 |
31 |
$0.00 |