| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99402 |
|
6,261 |
5,961 |
$485K |
| G9011 |
Coordinated care fee, risk adjusted maintenance, level 5 |
3,252 |
3,252 |
$130K |
| H1000 |
Prenatal care, at-risk assessment |
599 |
595 |
$50K |
| V5008 |
Hearing screening |
3,897 |
3,884 |
$36K |
| 36416 |
|
3,605 |
3,548 |
$33K |
| 99172 |
|
3,425 |
3,424 |
$32K |
| 0012A |
|
598 |
598 |
$22K |
| 0011A |
|
636 |
636 |
$21K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,525 |
1,502 |
$15K |
| H2000 |
Comprehensive multidisciplinary evaluation |
122 |
122 |
$12K |
| D1206 |
Topical application of fluoride varnish |
307 |
303 |
$10K |
| D0191 |
|
348 |
348 |
$9K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
479 |
477 |
$8K |
| S0215 |
Non-emergency transportation; mileage, per mile |
155 |
118 |
$8K |
| 85018 |
|
3,087 |
3,071 |
$7K |
| T1023 |
Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter |
64 |
64 |
$6K |
| D0190 |
|
299 |
295 |
$5K |
| 0001A |
|
132 |
131 |
$4K |
| 0002A |
|
121 |
121 |
$4K |
| 90686 |
|
339 |
338 |
$3K |
| 90632 |
|
31 |
31 |
$2K |
| 90746 |
|
14 |
14 |
$886.20 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
29 |
28 |
$696.24 |
| 0064A |
|
12 |
12 |
$454.20 |
| 90715 |
|
25 |
25 |
$301.76 |
| 90707 |
|
14 |
14 |
$231.45 |
| 90620 |
|
13 |
13 |
$169.60 |
| 90656 |
|
14 |
14 |
$156.45 |
| 81025 |
|
14 |
13 |
$12.46 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
12 |
12 |
$3.07 |
| 91300 |
|
262 |
254 |
$0.00 |
| 83655 |
|
32 |
32 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| 90734 |
|
14 |
14 |
$0.00 |
| 91306 |
|
12 |
12 |
$0.00 |
| 91301 |
|
1,238 |
1,203 |
$0.00 |