| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90472 |
Immunization administration, each additional vaccine (list separately) |
5,193 |
5,038 |
$33K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,907 |
6,600 |
$32K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
387 |
272 |
$25K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
519 |
311 |
$15K |
| 90723 |
|
889 |
864 |
$10K |
| 90474 |
|
2,142 |
2,086 |
$7K |
| 90633 |
|
1,479 |
1,445 |
$7K |
| D1330 |
|
89 |
89 |
$5K |
| D1351 |
Sealant - per tooth |
247 |
60 |
$3K |
| 90670 |
|
2,780 |
2,689 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
47 |
37 |
$2K |
| 90686 |
|
1,719 |
1,622 |
$2K |
| 90680 |
|
2,071 |
2,006 |
$1K |
| 90696 |
|
260 |
256 |
$885.50 |
| 90648 |
|
1,181 |
1,149 |
$726.00 |
| 90700 |
|
265 |
254 |
$599.50 |
| 90715 |
|
176 |
161 |
$484.00 |
| D0191 |
|
72 |
72 |
$423.28 |
| D9999 |
Unspecified adjunctive procedure, by report |
20 |
20 |
$400.00 |
| D0190 |
|
28 |
28 |
$383.44 |
| 90698 |
|
869 |
837 |
$357.50 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
47 |
25 |
$348.52 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
147 |
136 |
$319.50 |
| 90707 |
|
237 |
234 |
$176.00 |
| 90710 |
|
617 |
605 |
$126.50 |
| 90716 |
|
260 |
257 |
$121.00 |
| 90651 |
|
100 |
96 |
$115.50 |
| 90734 |
|
93 |
89 |
$60.50 |
| 90682 |
|
71 |
47 |
$18.12 |
| 90671 |
|
372 |
359 |
$0.00 |
| 90697 |
|
806 |
780 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
105 |
87 |
$0.00 |
| 90656 |
|
24 |
24 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
12 |
12 |
$0.00 |