| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99402 |
|
7,699 |
5,885 |
$632K |
| H2000 |
Comprehensive multidisciplinary evaluation |
309 |
308 |
$33K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,472 |
2,460 |
$22K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,174 |
1,171 |
$20K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
977 |
974 |
$19K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,390 |
1,350 |
$18K |
| 96167 |
|
62 |
38 |
$6K |
| 99172 |
|
571 |
554 |
$5K |
| V5008 |
Hearing screening |
569 |
554 |
$5K |
| 90686 |
|
880 |
877 |
$5K |
| D0190 |
|
313 |
299 |
$4K |
| 99188 |
|
602 |
602 |
$4K |
| 96168 |
|
56 |
36 |
$1K |
| H1000 |
Prenatal care, at-risk assessment |
14 |
14 |
$1K |
| 90651 |
|
31 |
31 |
$645.00 |
| 90716 |
|
57 |
57 |
$521.26 |
| 90715 |
|
66 |
65 |
$380.65 |
| 90670 |
|
131 |
131 |
$364.00 |
| 90734 |
|
93 |
92 |
$240.00 |
| 90656 |
|
34 |
34 |
$160.00 |
| 90473 |
|
32 |
32 |
$96.00 |
| 90474 |
|
28 |
28 |
$84.00 |
| 86580 |
|
16 |
16 |
$72.96 |
| D1206 |
Topical application of fluoride varnish |
40 |
40 |
$45.00 |
| S4993 |
Contraceptive pills for birth control |
12 |
12 |
$30.48 |
| 90685 |
|
39 |
39 |
$0.00 |
| 90633 |
|
70 |
70 |
$0.00 |
| 90672 |
|
48 |
48 |
$0.00 |
| 90707 |
|
28 |
28 |
$0.00 |
| 90698 |
|
88 |
88 |
$0.00 |
| 90744 |
|
14 |
14 |
$0.00 |