| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,818 |
1,797 |
$61K |
| 90461 |
|
480 |
476 |
$25K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
169 |
159 |
$6K |
| 0012A |
|
170 |
160 |
$3K |
| 0031A |
|
80 |
78 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
27 |
26 |
$2K |
| 0011A |
|
173 |
162 |
$2K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
27 |
27 |
$1K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
27 |
27 |
$1K |
| 90734 |
|
610 |
602 |
$1K |
| 90651 |
|
341 |
335 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 90633 |
|
702 |
692 |
$853.00 |
| D1206 |
Topical application of fluoride varnish |
37 |
36 |
$618.75 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
14 |
12 |
$565.44 |
| 90619 |
|
25 |
24 |
$410.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
13 |
$293.93 |
| 81025 |
|
165 |
159 |
$263.24 |
| 92551 |
|
20 |
20 |
$203.74 |
| 90688 |
|
26 |
25 |
$194.90 |
| 90715 |
|
212 |
211 |
$110.40 |
| 99173 |
|
19 |
19 |
$47.88 |
| 90686 |
|
17 |
17 |
$18.40 |
| 91303 |
|
62 |
62 |
$0.00 |
| 91301 |
|
317 |
301 |
$0.00 |