| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V5008 |
Hearing screening |
5,837 |
5,816 |
$54K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,651 |
1,644 |
$31K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,789 |
2,769 |
$27K |
| 99172 |
|
2,725 |
2,722 |
$25K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,894 |
1,863 |
$24K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,999 |
1,983 |
$22K |
| 36416 |
|
2,651 |
2,524 |
$16K |
| 81025 |
|
473 |
462 |
$3K |
| 90651 |
|
231 |
231 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
37 |
37 |
$3K |
| 87808 |
|
224 |
224 |
$3K |
| 90686 |
|
525 |
524 |
$2K |
| 87905 |
|
205 |
205 |
$2K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
613 |
602 |
$1K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
621 |
610 |
$1K |
| 90715 |
|
255 |
255 |
$858.99 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
58 |
57 |
$442.09 |
| 90734 |
|
269 |
269 |
$380.20 |
| 90707 |
|
14 |
14 |
$300.00 |
| 36415 |
Collection of venous blood by venipuncture |
53 |
50 |
$286.80 |
| 90670 |
|
67 |
67 |
$193.00 |
| 90473 |
|
14 |
14 |
$192.64 |
| 90716 |
|
12 |
12 |
$136.26 |
| 83655 |
|
24 |
23 |
$110.33 |
| 87850 |
|
255 |
251 |
$5.00 |
| 90633 |
|
207 |
207 |
$0.00 |
| 90672 |
|
16 |
16 |
$0.00 |
| A4267 |
Contraceptive supply, condom, male, each |
277 |
276 |
$0.00 |
| 87806 |
|
97 |
97 |
$0.00 |
| 90710 |
|
75 |
75 |
$0.00 |
| 90685 |
|
52 |
52 |
$0.00 |
| 87490 |
|
261 |
255 |
$0.00 |
| 90696 |
|
12 |
12 |
$0.00 |
| 86593 |
|
12 |
12 |
$0.00 |
| 86803 |
|
14 |
14 |
$0.00 |
| 86592 |
|
13 |
13 |
$0.00 |