| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
520 |
508 |
$67K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,127 |
2,022 |
$15K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,434 |
1,337 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
42 |
42 |
$7K |
| D0191 |
|
122 |
120 |
$7K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
53 |
52 |
$6K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
158 |
150 |
$6K |
| 99385 |
|
40 |
40 |
$5K |
| D1330 |
|
121 |
120 |
$241.70 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$240.00 |
| D1351 |
Sealant - per tooth |
67 |
20 |
$135.26 |
| D1206 |
Topical application of fluoride varnish |
121 |
120 |
$96.62 |
| 90715 |
|
275 |
258 |
$69.50 |
| 90696 |
|
28 |
27 |
$27.50 |
| 90686 |
|
74 |
72 |
$5.50 |
| 90633 |
|
45 |
43 |
$0.00 |
| 90734 |
|
48 |
46 |
$0.00 |
| 90710 |
|
92 |
90 |
$0.00 |
| 90671 |
|
24 |
24 |
$0.00 |
| 90744 |
|
13 |
13 |
$0.00 |
| 90651 |
|
130 |
120 |
$0.00 |