| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,860 |
1,807 |
$70K |
| 90461 |
|
834 |
799 |
$50K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
938 |
867 |
$34K |
| 90632 |
|
81 |
80 |
$5K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
214 |
191 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
157 |
151 |
$3K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
57 |
57 |
$3K |
| D1206 |
Topical application of fluoride varnish |
143 |
140 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
70 |
70 |
$2K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
40 |
40 |
$2K |
| 97802 |
|
42 |
42 |
$2K |
| 90651 |
|
266 |
261 |
$1K |
| 86580 |
|
183 |
159 |
$1K |
| 99442 |
|
52 |
52 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
17 |
17 |
$1K |
| 90688 |
|
96 |
95 |
$820.50 |
| 90633 |
|
1,042 |
1,022 |
$777.50 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$747.23 |
| 90734 |
|
122 |
119 |
$368.10 |
| 83655 |
|
19 |
19 |
$329.46 |
| 90670 |
|
299 |
287 |
$257.60 |
| 81025 |
|
150 |
149 |
$246.77 |
| 90647 |
|
140 |
134 |
$165.60 |
| 90723 |
|
175 |
170 |
$128.80 |
| A4267 |
Contraceptive supply, condom, male, each |
12 |
12 |
$65.00 |
| 90696 |
|
24 |
24 |
$36.80 |
| 90715 |
|
22 |
22 |
$36.80 |
| 90710 |
|
12 |
12 |
$9.90 |
| G0008 |
Administration of influenza virus vaccine |
24 |
23 |
$0.00 |
| 90662 |
|
21 |
20 |
$0.00 |