| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,094 |
1,091 |
$20K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,842 |
1,829 |
$17K |
| 99402 |
|
96 |
96 |
$9K |
| 90686 |
|
415 |
413 |
$2K |
| 90651 |
|
135 |
135 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
88 |
87 |
$1K |
| 90715 |
|
184 |
184 |
$531.56 |
| 36416 |
|
68 |
62 |
$440.10 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$325.00 |
| 81025 |
|
41 |
40 |
$291.26 |
| A4267 |
Contraceptive supply, condom, male, each |
117 |
110 |
$41.10 |
| 90734 |
|
98 |
98 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
93 |
93 |
$0.00 |
| 90710 |
|
62 |
62 |
$0.00 |
| 90670 |
|
90 |
90 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
25 |
25 |
$0.00 |
| 90633 |
|
139 |
139 |
$0.00 |
| 90700 |
|
25 |
25 |
$0.00 |
| 87490 |
|
13 |
13 |
$0.00 |
| 90698 |
|
12 |
12 |
$0.00 |
| 90619 |
|
69 |
69 |
$0.00 |
| 87850 |
|
12 |
12 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
25 |
25 |
$0.00 |
| 90744 |
|
12 |
12 |
$0.00 |
| 90696 |
|
12 |
12 |
$0.00 |