| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,769 |
1,570 |
$15K |
| 90715 |
|
251 |
249 |
$333.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
13 |
13 |
$280.53 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
13 |
13 |
$279.63 |
| 90686 |
|
315 |
312 |
$276.52 |
| 99000 |
|
96 |
95 |
$166.62 |
| 90633 |
|
56 |
56 |
$126.00 |
| 90710 |
|
79 |
79 |
$117.00 |
| 90651 |
|
88 |
88 |
$108.00 |
| 90688 |
|
48 |
48 |
$75.90 |
| 86580 |
|
335 |
326 |
$74.27 |
| 90696 |
|
50 |
50 |
$54.00 |
| 86592 |
|
59 |
58 |
$52.82 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
302 |
301 |
$40.46 |
| 90619 |
|
21 |
21 |
$36.00 |
| A4268 |
Contraceptive supply, condom, female, each |
15 |
15 |
$33.00 |
| 90734 |
|
60 |
60 |
$27.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
72 |
72 |
$13.46 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
116 |
116 |
$9.00 |
| 90656 |
|
12 |
12 |
$0.00 |
| S5199 |
Personal care item, nos, each |
13 |
13 |
$0.00 |
| 90461 |
|
46 |
46 |
$0.00 |
| 83655 |
|
19 |
19 |
$0.00 |