| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1017 |
Targeted case management, each 15 minutes |
1,522 |
1,071 |
$380K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,678 |
6,505 |
$116K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,588 |
3,520 |
$79K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,072 |
1,980 |
$39K |
| 90473 |
|
2,427 |
2,425 |
$39K |
| D0191 |
|
1,428 |
1,428 |
$21K |
| 90715 |
|
1,561 |
1,528 |
$16K |
| 0001A |
|
472 |
465 |
$15K |
| 0002A |
|
422 |
417 |
$15K |
| 91320 |
|
175 |
175 |
$13K |
| 90651 |
|
1,132 |
1,122 |
$12K |
| 90480 |
|
312 |
311 |
$10K |
| 90686 |
|
1,502 |
1,474 |
$8K |
| 90716 |
|
565 |
555 |
$8K |
| 83655 |
|
606 |
602 |
$7K |
| D1351 |
Sealant - per tooth |
380 |
109 |
$7K |
| 90713 |
|
699 |
686 |
$4K |
| 0071A |
|
88 |
88 |
$4K |
| 36416 |
|
1,044 |
1,025 |
$3K |
| 0072A |
|
83 |
83 |
$3K |
| 0004A |
|
73 |
71 |
$2K |
| 0012A |
|
65 |
63 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
13 |
$2K |
| 90707 |
|
89 |
89 |
$1K |
| 0003A |
|
35 |
35 |
$1K |
| 90656 |
|
151 |
151 |
$1K |
| 90746 |
|
24 |
24 |
$1K |
| 0124A |
|
37 |
37 |
$1K |
| 0052A |
|
27 |
27 |
$1K |
| 0011A |
|
71 |
69 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
13 |
$911.69 |
| 0054A |
|
21 |
21 |
$840.00 |
| 90688 |
|
160 |
160 |
$672.00 |
| 90672 |
|
2,176 |
2,168 |
$635.71 |
| 86580 |
|
95 |
74 |
$617.71 |
| 90619 |
|
444 |
444 |
$573.60 |
| 0051A |
|
14 |
14 |
$560.00 |
| 90662 |
|
55 |
49 |
$545.66 |
| 36415 |
Collection of venous blood by venipuncture |
200 |
195 |
$511.41 |
| 85018 |
|
206 |
206 |
$470.57 |
| 90734 |
|
403 |
400 |
$451.51 |
| D1206 |
Topical application of fluoride varnish |
1,452 |
1,452 |
$299.52 |
| 90621 |
|
118 |
118 |
$241.00 |
| G0008 |
Administration of influenza virus vaccine |
61 |
54 |
$160.16 |
| 90660 |
|
358 |
358 |
$147.77 |
| 81025 |
|
15 |
12 |
$93.00 |
| 90710 |
|
151 |
151 |
$0.65 |
| 90633 |
|
856 |
847 |
$0.00 |
| 91308 |
|
27 |
25 |
$0.00 |
| 91300 |
|
951 |
881 |
$0.00 |
| 91312 |
|
81 |
81 |
$0.00 |
| 90670 |
|
41 |
41 |
$0.00 |
| 82947 |
|
26 |
26 |
$0.00 |
| 90674 |
|
289 |
289 |
$0.00 |
| 91301 |
|
134 |
130 |
$0.00 |
| 91319 |
|
28 |
28 |
$0.00 |
| 91307 |
|
240 |
232 |
$0.00 |
| 90744 |
|
58 |
58 |
$0.00 |
| 82962 |
|
132 |
130 |
$0.00 |
| 91305 |
|
315 |
178 |
$0.00 |
| 90696 |
|
121 |
121 |
$0.00 |
| 90698 |
|
26 |
26 |
$0.00 |
| 91318 |
|
14 |
14 |
$0.00 |