| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99402 |
|
5,832 |
5,355 |
$455K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,203 |
2,111 |
$40K |
| 99172 |
|
3,673 |
3,652 |
$34K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,455 |
3,310 |
$31K |
| V5008 |
Hearing screening |
3,150 |
3,124 |
$29K |
| H2000 |
Comprehensive multidisciplinary evaluation |
185 |
183 |
$19K |
| 83655 |
|
1,285 |
1,177 |
$16K |
| 0012A |
|
285 |
285 |
$10K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
758 |
741 |
$8K |
| 0011A |
|
332 |
332 |
$8K |
| G9011 |
Coordinated care fee, risk adjusted maintenance, level 5 |
166 |
125 |
$7K |
| D0191 |
|
226 |
222 |
$6K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
592 |
588 |
$5K |
| 90651 |
|
360 |
306 |
$5K |
| H1000 |
Prenatal care, at-risk assessment |
55 |
55 |
$4K |
| 0031A |
|
106 |
106 |
$4K |
| 0064A |
|
64 |
64 |
$2K |
| 90686 |
|
542 |
507 |
$2K |
| 0002A |
|
39 |
39 |
$1K |
| 0001A |
|
45 |
45 |
$1K |
| T1023 |
Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter |
14 |
14 |
$1K |
| 90715 |
|
292 |
248 |
$1K |
| 0071A |
|
16 |
14 |
$529.90 |
| 36416 |
|
97 |
97 |
$492.74 |
| 0072A |
|
13 |
13 |
$492.05 |
| 90632 |
|
13 |
12 |
$400.00 |
| 90734 |
|
289 |
239 |
$386.55 |
| 90688 |
|
65 |
60 |
$374.64 |
| 90480 |
|
12 |
12 |
$299.94 |
| 90670 |
|
327 |
294 |
$215.33 |
| 81025 |
|
28 |
27 |
$192.51 |
| 90707 |
|
30 |
30 |
$73.00 |
| A4267 |
Contraceptive supply, condom, male, each |
42 |
42 |
$28.08 |
| 90633 |
|
493 |
440 |
$0.00 |
| 90685 |
|
144 |
128 |
$0.00 |
| 91300 |
|
123 |
114 |
$0.00 |
| 90710 |
|
21 |
13 |
$0.00 |
| 90700 |
|
13 |
13 |
$0.00 |
| 91301 |
|
640 |
639 |
$0.00 |
| 90744 |
|
13 |
13 |
$0.00 |
| 90677 |
|
13 |
13 |
$0.00 |
| 91307 |
|
64 |
56 |
$0.00 |
| 90619 |
|
16 |
16 |
$0.00 |
| 91306 |
|
64 |
64 |
$0.00 |
| 91303 |
|
105 |
105 |
$0.00 |
| 90698 |
|
70 |
69 |
$0.00 |
| 91305 |
|
14 |
14 |
$0.00 |