| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1017 |
Targeted case management, each 15 minutes |
2,041 |
1,375 |
$509K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,820 |
2,612 |
$121K |
| 90461 |
|
1,446 |
1,304 |
$58K |
| D0191 |
|
2,931 |
2,922 |
$42K |
| S9470 |
Nutritional counseling, dietitian visit |
964 |
950 |
$24K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
873 |
864 |
$13K |
| D1351 |
Sealant - per tooth |
476 |
147 |
$9K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
455 |
451 |
$8K |
| 0002A |
|
191 |
191 |
$7K |
| 0001A |
|
229 |
228 |
$7K |
| 91320 |
|
34 |
34 |
$3K |
| 90651 |
|
341 |
322 |
$2K |
| 90480 |
|
37 |
35 |
$920.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
12 |
12 |
$720.00 |
| 90715 |
|
662 |
439 |
$592.58 |
| 0004A |
|
26 |
23 |
$520.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
28 |
25 |
$444.48 |
| 90674 |
|
343 |
330 |
$406.32 |
| 99001 |
|
67 |
40 |
$405.92 |
| 90694 |
|
17 |
13 |
$358.68 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
16 |
16 |
$342.08 |
| 0012A |
|
13 |
13 |
$340.68 |
| 90686 |
|
318 |
313 |
$336.89 |
| 90734 |
|
466 |
445 |
$328.38 |
| 0011A |
|
13 |
13 |
$169.40 |
| 90716 |
|
29 |
28 |
$160.26 |
| 90707 |
|
34 |
18 |
$140.38 |
| 86580 |
|
17 |
17 |
$136.51 |
| 90649 |
|
34 |
34 |
$131.73 |
| 90619 |
|
159 |
158 |
$114.72 |
| 90633 |
|
321 |
312 |
$35.86 |
| 90710 |
|
230 |
145 |
$28.49 |
| 90723 |
|
46 |
29 |
$28.49 |
| 90672 |
|
44 |
44 |
$10.65 |
| 90670 |
|
261 |
257 |
$10.55 |
| 90660 |
|
14 |
14 |
$1.00 |
| 91300 |
|
308 |
286 |
$0.00 |
| 90685 |
|
19 |
17 |
$0.00 |
| 91307 |
|
14 |
14 |
$0.00 |
| 90698 |
|
122 |
71 |
$0.00 |
| 90696 |
|
172 |
102 |
$0.00 |
| 90688 |
|
14 |
14 |
$0.00 |
| 90680 |
|
14 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,904 |
2,895 |
$-85.41 |