| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
790 |
765 |
$28K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
502 |
449 |
$17K |
| 90461 |
|
206 |
197 |
$10K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
118 |
113 |
$5K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
104 |
101 |
$5K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
69 |
66 |
$4K |
| 0012A |
|
213 |
156 |
$3K |
| 90632 |
|
57 |
54 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
128 |
92 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
114 |
98 |
$2K |
| 0011A |
|
236 |
166 |
$2K |
| 0001A |
|
43 |
33 |
$1K |
| 0002A |
|
41 |
34 |
$1K |
| 90633 |
|
503 |
478 |
$956.80 |
| 90651 |
|
118 |
112 |
$944.50 |
| 90734 |
|
145 |
140 |
$729.60 |
| D1206 |
Topical application of fluoride varnish |
32 |
32 |
$600.00 |
| 86803 |
|
29 |
27 |
$504.92 |
| 86592 |
|
78 |
76 |
$433.81 |
| 0064A |
|
35 |
14 |
$400.00 |
| 90688 |
|
37 |
27 |
$358.00 |
| 90715 |
|
57 |
56 |
$126.48 |
| 86580 |
|
16 |
14 |
$102.60 |
| 36415 |
Collection of venous blood by venipuncture |
83 |
80 |
$27.00 |
| 91301 |
|
422 |
318 |
$0.00 |