| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,413 |
3,104 |
$205K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
2,448 |
2,393 |
$117K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
2,433 |
2,380 |
$117K |
| D1120 |
Prophylaxis - child |
752 |
717 |
$39K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,775 |
574 |
$29K |
| D0191 |
|
1,053 |
1,016 |
$23K |
| 90632 |
|
403 |
383 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,354 |
1,300 |
$22K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
316 |
287 |
$18K |
| D1351 |
Sealant - per tooth |
216 |
205 |
$18K |
| 83655 |
|
870 |
857 |
$14K |
| 90686 |
|
862 |
849 |
$12K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
630 |
598 |
$12K |
| 90633 |
|
487 |
482 |
$9K |
| 90670 |
|
491 |
486 |
$8K |
| 90651 |
|
47 |
47 |
$8K |
| 86592 |
|
1,287 |
1,268 |
$7K |
| 0011A |
|
222 |
221 |
$6K |
| 90734 |
|
77 |
76 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
222 |
218 |
$5K |
| 0012A |
|
126 |
126 |
$5K |
| 0031A |
|
133 |
130 |
$4K |
| 90698 |
|
208 |
205 |
$4K |
| 99201 |
|
88 |
69 |
$2K |
| 99499 |
|
76 |
33 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
24 |
24 |
$2K |
| 90688 |
|
62 |
61 |
$1K |
| 92551 |
|
64 |
64 |
$627.60 |
| 0001A |
|
17 |
16 |
$520.00 |
| 90710 |
|
14 |
14 |
$257.60 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
59 |
52 |
$239.98 |
| 90723 |
|
12 |
12 |
$220.80 |
| 90636 |
|
12 |
12 |
$165.60 |
| 36415 |
Collection of venous blood by venipuncture |
77 |
62 |
$135.00 |
| 82120 |
|
15 |
12 |
$64.68 |
| 87210 |
|
12 |
12 |
$51.50 |
| 99173 |
|
102 |
101 |
$37.80 |
| D0603 |
|
146 |
133 |
$0.00 |
| 91301 |
|
212 |
208 |
$0.00 |
| D1310 |
|
154 |
142 |
$0.00 |
| D1330 |
|
256 |
239 |
$0.00 |
| 91303 |
|
30 |
30 |
$0.00 |
| D0601 |
|
35 |
35 |
$0.00 |