| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,075 |
1,871 |
$278K |
| D1206 |
Topical application of fluoride varnish |
317 |
287 |
$10K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
686 |
659 |
$6K |
| 99403 |
|
12 |
12 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
19 |
16 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
392 |
350 |
$951.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
43 |
33 |
$860.00 |
| D0191 |
|
328 |
298 |
$327.80 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
84 |
73 |
$258.00 |
| 90686 |
|
41 |
37 |
$121.00 |
| 90696 |
|
14 |
14 |
$115.50 |
| 90715 |
|
49 |
43 |
$99.00 |
| D1330 |
|
316 |
287 |
$49.48 |
| 90710 |
|
19 |
19 |
$27.50 |