| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,679 |
3,150 |
$43K |
| 96160 |
|
1,473 |
915 |
$20K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
257 |
171 |
$14K |
| D1206 |
Topical application of fluoride varnish |
379 |
373 |
$10K |
| 0012A |
|
183 |
170 |
$7K |
| 90651 |
|
231 |
199 |
$6K |
| 0011A |
|
225 |
180 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
383 |
379 |
$6K |
| 90686 |
|
542 |
477 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
248 |
144 |
$6K |
| 90734 |
|
279 |
225 |
$5K |
| 90670 |
|
421 |
374 |
$4K |
| 99401 |
|
144 |
105 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
101 |
54 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
107 |
87 |
$4K |
| 90715 |
|
238 |
198 |
$3K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
85 |
76 |
$3K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
82 |
75 |
$3K |
| 90619 |
|
138 |
125 |
$3K |
| 96127 |
|
131 |
96 |
$2K |
| 0031A |
|
36 |
31 |
$1K |
| 90633 |
|
106 |
82 |
$1K |
| 90677 |
|
25 |
25 |
$1K |
| 90723 |
|
135 |
128 |
$1K |
| 90680 |
|
77 |
71 |
$575.69 |
| 90620 |
|
12 |
12 |
$551.35 |
| 90710 |
|
41 |
39 |
$417.05 |
| 90656 |
|
20 |
19 |
$351.63 |
| 81025 |
|
111 |
44 |
$320.17 |
| 90647 |
|
43 |
39 |
$291.80 |
| A4267 |
Contraceptive supply, condom, male, each |
33 |
14 |
$248.06 |
| 36416 |
|
52 |
52 |
$212.87 |
| 87210 |
|
22 |
14 |
$96.35 |
| 0064A |
|
16 |
16 |
$86.03 |
| 90696 |
|
12 |
12 |
$76.80 |
| S0613 |
Annual gynecological examination; clinical breast examination without pelvic evaluation |
34 |
13 |
$15.00 |
| 91301 |
|
341 |
303 |
$0.00 |
| 91303 |
|
26 |
26 |
$0.00 |
| 91306 |
|
18 |
18 |
$0.00 |