| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99402 |
|
4,424 |
3,827 |
$366K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,066 |
4,018 |
$40K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,217 |
2,205 |
$40K |
| V5008 |
Hearing screening |
2,660 |
2,611 |
$24K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,647 |
1,611 |
$19K |
| H2000 |
Comprehensive multidisciplinary evaluation |
162 |
162 |
$17K |
| 0011A |
|
571 |
571 |
$16K |
| 99172 |
|
1,723 |
1,715 |
$16K |
| 0012A |
|
511 |
509 |
$15K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,311 |
1,301 |
$14K |
| H0045 |
Respite care services, not in the home, per diem |
220 |
55 |
$14K |
| 90632 |
|
225 |
219 |
$10K |
| 90686 |
|
907 |
904 |
$6K |
| 90480 |
|
140 |
139 |
$4K |
| 0064A |
|
136 |
136 |
$4K |
| 0001A |
|
123 |
123 |
$4K |
| 91320 |
|
42 |
42 |
$4K |
| 90651 |
|
246 |
246 |
$3K |
| 0071A |
|
102 |
102 |
$3K |
| S4993 |
Contraceptive pills for birth control |
231 |
209 |
$3K |
| 0002A |
|
97 |
97 |
$3K |
| 83655 |
|
271 |
271 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
29 |
27 |
$2K |
| 0072A |
|
76 |
76 |
$2K |
| 91322 |
|
19 |
19 |
$2K |
| 90715 |
|
297 |
297 |
$2K |
| 0031A |
|
37 |
37 |
$1K |
| H1000 |
Prenatal care, at-risk assessment |
14 |
14 |
$1K |
| S0215 |
Non-emergency transportation; mileage, per mile |
38 |
12 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
38 |
38 |
$1K |
| 90691 |
|
12 |
12 |
$960.00 |
| 0004A |
|
29 |
29 |
$840.00 |
| 0134A |
|
36 |
36 |
$694.58 |
| 90677 |
|
37 |
37 |
$550.00 |
| 85018 |
|
273 |
273 |
$472.43 |
| 0111A |
|
14 |
13 |
$396.63 |
| 0074A |
|
12 |
12 |
$360.00 |
| 90734 |
|
164 |
164 |
$330.00 |
| 90656 |
|
17 |
17 |
$319.08 |
| 99188 |
|
24 |
24 |
$179.04 |
| 90619 |
|
52 |
52 |
$140.00 |
| 91307 |
|
232 |
227 |
$0.00 |
| 91301 |
|
1,048 |
1,047 |
$0.00 |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
457 |
445 |
$0.00 |
| 91303 |
|
37 |
37 |
$0.00 |
| 90647 |
|
12 |
12 |
$0.00 |
| 91306 |
|
132 |
132 |
$0.00 |
| 90696 |
|
12 |
12 |
$0.00 |
| 90633 |
|
132 |
130 |
$0.00 |
| 91300 |
|
346 |
339 |
$0.00 |
| 90670 |
|
214 |
211 |
$0.00 |
| 91308 |
|
42 |
36 |
$0.00 |
| 90710 |
|
98 |
98 |
$0.00 |
| A4267 |
Contraceptive supply, condom, male, each |
17 |
17 |
$0.00 |
| 91313 |
|
36 |
36 |
$0.00 |
| 90685 |
|
15 |
14 |
$0.00 |
| 91311 |
|
14 |
12 |
$0.00 |