| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0001A |
|
5,482 |
5,480 |
$202K |
| 0002A |
|
4,869 |
4,867 |
$188K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,264 |
3,190 |
$119K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,577 |
1,464 |
$118K |
| 0004A |
|
2,167 |
2,164 |
$85K |
| H0033 |
Oral medication administration, direct observation |
885 |
878 |
$82K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,167 |
1,102 |
$64K |
| 0012A |
|
1,858 |
1,857 |
$56K |
| 0011A |
|
1,978 |
1,976 |
$53K |
| 99215 |
Prolong outpt/office vis |
424 |
417 |
$47K |
| 0031A |
|
1,187 |
1,187 |
$44K |
| 0064A |
|
766 |
766 |
$29K |
| G0008 |
Administration of influenza virus vaccine |
1,593 |
1,593 |
$26K |
| 99401 |
|
1,045 |
1,041 |
$26K |
| 86703 |
|
1,955 |
1,952 |
$25K |
| 0071A |
|
599 |
599 |
$24K |
| 0072A |
|
498 |
498 |
$20K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
213 |
212 |
$16K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
824 |
718 |
$14K |
| 90707 |
|
193 |
171 |
$12K |
| 0054A |
|
163 |
163 |
$6K |
| 90715 |
|
434 |
141 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
354 |
352 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
77 |
76 |
$6K |
| 90686 |
|
402 |
308 |
$6K |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
231 |
230 |
$5K |
| 86328 |
|
107 |
103 |
$5K |
| 87210 |
|
1,030 |
1,020 |
$5K |
| 96160 |
|
1,910 |
1,910 |
$5K |
| 0124A |
|
117 |
117 |
$5K |
| 90716 |
|
70 |
55 |
$4K |
| 90480 |
|
109 |
109 |
$4K |
| 99443 |
|
95 |
93 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
441 |
422 |
$4K |
| 90632 |
|
78 |
54 |
$3K |
| 86580 |
|
500 |
484 |
$3K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
164 |
164 |
$3K |
| 0034A |
|
59 |
59 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
141 |
140 |
$2K |
| 81025 |
|
262 |
258 |
$2K |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
429 |
368 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
927 |
915 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
104 |
99 |
$2K |
| 0052A |
|
33 |
33 |
$1K |
| 87205 |
|
332 |
330 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
12 |
$1K |
| 92551 |
|
142 |
142 |
$917.82 |
| G0010 |
Administration of hepatitis b vaccine |
54 |
54 |
$842.25 |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
18 |
18 |
$778.50 |
| 83986 |
|
297 |
293 |
$706.05 |
| 0051A |
|
16 |
16 |
$640.00 |
| 99423 |
|
14 |
13 |
$516.88 |
| 99173 |
|
138 |
138 |
$247.03 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$213.49 |
| 90713 |
|
14 |
14 |
$179.08 |
| 90734 |
|
40 |
34 |
$150.60 |
| 90619 |
|
48 |
45 |
$75.30 |
| 96127 |
|
13 |
13 |
$47.06 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
57 |
57 |
$40.71 |
| 91300 |
|
1,569 |
1,442 |
$2.52 |
| 91301 |
|
667 |
640 |
$0.62 |
| 91306 |
|
101 |
101 |
$0.20 |
| 91303 |
|
114 |
114 |
$0.00 |
| 91307 |
|
53 |
49 |
$0.00 |