| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V5008 |
Hearing screening |
11,547 |
11,512 |
$108K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,516 |
4,498 |
$90K |
| 99172 |
|
9,029 |
9,024 |
$84K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,226 |
6,182 |
$62K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,745 |
1,713 |
$53K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,744 |
1,712 |
$53K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,138 |
1,136 |
$40K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
258 |
255 |
$20K |
| 90651 |
|
863 |
856 |
$14K |
| 90632 |
|
191 |
191 |
$10K |
| 90715 |
|
1,356 |
1,350 |
$10K |
| 36416 |
|
1,604 |
1,602 |
$10K |
| 90716 |
|
357 |
356 |
$9K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
828 |
827 |
$9K |
| 86580 |
|
1,342 |
1,312 |
$7K |
| 90686 |
|
1,227 |
1,207 |
$5K |
| 85018 |
|
2,043 |
2,043 |
$4K |
| 81025 |
|
656 |
631 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
338 |
319 |
$4K |
| 90707 |
|
309 |
308 |
$4K |
| 86592 |
|
637 |
637 |
$2K |
| 91320 |
|
29 |
29 |
$2K |
| 90480 |
|
74 |
73 |
$2K |
| 90734 |
|
830 |
822 |
$1K |
| 90670 |
|
1,124 |
1,120 |
$1K |
| 90746 |
|
13 |
13 |
$822.90 |
| 90688 |
|
107 |
107 |
$588.72 |
| A4269 |
Contraceptive supply, spermicide (e.g., foam, gel), each |
81 |
73 |
$564.30 |
| 90619 |
|
400 |
400 |
$470.52 |
| 90474 |
|
120 |
120 |
$360.00 |
| 90620 |
|
40 |
40 |
$339.60 |
| 90656 |
|
36 |
36 |
$307.74 |
| 90677 |
|
92 |
92 |
$298.04 |
| 90621 |
|
20 |
20 |
$280.00 |
| 87210 |
|
26 |
26 |
$125.32 |
| 90698 |
|
345 |
345 |
$0.00 |
| 90723 |
|
170 |
170 |
$0.00 |
| 90696 |
|
184 |
179 |
$0.00 |
| 90744 |
|
196 |
196 |
$0.00 |
| 90647 |
|
343 |
343 |
$0.00 |
| 90680 |
|
133 |
133 |
$0.00 |
| 90700 |
|
284 |
283 |
$0.00 |
| 90710 |
|
478 |
473 |
$0.00 |
| 90633 |
|
718 |
716 |
$0.00 |
| 90713 |
|
133 |
132 |
$0.00 |
| 90685 |
|
33 |
33 |
$0.00 |