| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90472 |
Immunization administration, each additional vaccine (list separately) |
9,737 |
4,078 |
$47K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,970 |
5,440 |
$30K |
| G9012 |
Other specified case management service not elsewhere classified |
363 |
362 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,164 |
1,042 |
$17K |
| 86703 |
|
4,624 |
4,065 |
$15K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,662 |
1,466 |
$12K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
430 |
369 |
$8K |
| 86592 |
|
5,071 |
4,457 |
$7K |
| 87210 |
|
1,779 |
1,586 |
$4K |
| 86803 |
|
865 |
732 |
$4K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
202 |
182 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
424 |
330 |
$3K |
| 90480 |
|
153 |
139 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
466 |
354 |
$2K |
| 81025 |
|
389 |
369 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
64 |
64 |
$2K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
79 |
66 |
$1K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
191 |
155 |
$827.80 |
| A9150 |
Non-prescription drugs |
335 |
289 |
$265.44 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
49 |
30 |
$141.61 |
| 86780 |
|
38 |
26 |
$87.70 |
| 90715 |
|
1,322 |
1,192 |
$30.00 |
| 90686 |
|
931 |
852 |
$25.00 |
| 86593 |
|
47 |
37 |
$3.52 |
| 90620 |
|
561 |
509 |
$0.00 |
| 90619 |
|
534 |
501 |
$0.00 |
| 90651 |
|
1,623 |
1,477 |
$0.00 |
| 90716 |
|
325 |
300 |
$0.00 |
| 90698 |
|
16 |
15 |
$0.00 |
| 90744 |
|
351 |
322 |
$0.00 |
| 90696 |
|
281 |
251 |
$0.00 |
| 90656 |
|
93 |
93 |
$0.00 |
| 90723 |
|
89 |
86 |
$0.00 |
| 90633 |
|
1,596 |
1,466 |
$0.00 |
| 90700 |
|
367 |
340 |
$0.00 |
| 90710 |
|
1,093 |
1,001 |
$0.00 |
| 90714 |
|
31 |
31 |
$0.00 |
| 90734 |
|
604 |
583 |
$0.00 |
| 90713 |
|
629 |
568 |
$0.00 |
| 90707 |
|
155 |
138 |
$0.00 |
| 90670 |
|
352 |
311 |
$0.00 |