| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
211 |
202 |
$12K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
188 |
175 |
$7K |
| D1206 |
Topical application of fluoride varnish |
355 |
342 |
$6K |
| D0191 |
|
289 |
269 |
$6K |
| 90461 |
|
87 |
80 |
$5K |
| 90632 |
|
44 |
41 |
$3K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
33 |
32 |
$1K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
33 |
32 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
51 |
44 |
$949.62 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
14 |
$515.13 |
| 90651 |
|
12 |
12 |
$188.90 |
| 90633 |
|
49 |
49 |
$55.20 |
| 81025 |
|
27 |
24 |
$36.12 |
| 90688 |
|
13 |
13 |
$18.40 |
| A4267 |
Contraceptive supply, condom, male, each |
13 |
13 |
$18.25 |