| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,066 |
2,029 |
$57K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
971 |
706 |
$51K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,058 |
970 |
$46K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,026 |
942 |
$45K |
| 90632 |
|
486 |
451 |
$25K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
905 |
836 |
$18K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
374 |
320 |
$13K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
255 |
239 |
$11K |
| 0031A |
|
242 |
232 |
$7K |
| D1206 |
Topical application of fluoride varnish |
414 |
411 |
$7K |
| 90686 |
|
1,853 |
1,791 |
$6K |
| 90461 |
|
170 |
158 |
$6K |
| 0012A |
|
288 |
274 |
$5K |
| 0001A |
|
137 |
135 |
$5K |
| 0011A |
|
324 |
308 |
$5K |
| 90651 |
|
247 |
243 |
$4K |
| 0002A |
|
100 |
97 |
$4K |
| 0071A |
|
47 |
47 |
$2K |
| 0072A |
|
42 |
42 |
$2K |
| 0064A |
|
125 |
100 |
$1K |
| 0134A |
|
62 |
56 |
$1K |
| 0003A |
|
22 |
22 |
$880.00 |
| 92551 |
|
91 |
90 |
$868.18 |
| 81025 |
|
634 |
520 |
$862.68 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
81 |
81 |
$855.80 |
| 90746 |
|
17 |
17 |
$840.40 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
15 |
14 |
$762.34 |
| 90715 |
|
103 |
102 |
$605.76 |
| 90480 |
|
12 |
12 |
$480.00 |
| 90633 |
|
271 |
270 |
$478.40 |
| 90734 |
|
125 |
124 |
$440.00 |
| 90620 |
|
63 |
62 |
$411.50 |
| 85018 |
|
107 |
106 |
$271.75 |
| 86803 |
|
13 |
13 |
$252.46 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$251.01 |
| Q0112 |
All potassium hydroxide (koh) preparations |
28 |
28 |
$168.68 |
| 99173 |
|
73 |
73 |
$151.20 |
| 82120 |
|
28 |
28 |
$150.92 |
| Q0111 |
Wet mounts, including preparations of vaginal, cervical or skin specimens |
28 |
28 |
$142.06 |
| 81002 |
|
100 |
99 |
$134.55 |
| 86780 |
|
12 |
12 |
$108.48 |
| 36416 |
|
56 |
56 |
$93.00 |
| 91301 |
|
365 |
344 |
$0.01 |
| 888888 |
|
12 |
12 |
$0.00 |
| 90662 |
|
12 |
12 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
50 |
50 |
$0.00 |