| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,934 |
2,771 |
$26K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,099 |
1,661 |
$26K |
| 81025 |
|
906 |
823 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
79 |
77 |
$3K |
| 0111A |
|
54 |
52 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
70 |
66 |
$2K |
| 0081A |
|
42 |
42 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
117 |
113 |
$1K |
| 0082A |
|
33 |
33 |
$1K |
| 86592 |
|
321 |
311 |
$1K |
| 90715 |
|
293 |
286 |
$900.29 |
| 0112A |
|
22 |
22 |
$880.00 |
| A4267 |
Contraceptive supply, condom, male, each |
59 |
54 |
$679.68 |
| H0033 |
Oral medication administration, direct observation |
90 |
12 |
$679.58 |
| 0071A |
|
16 |
16 |
$598.00 |
| 0074A |
|
16 |
16 |
$560.00 |
| 81001 |
|
191 |
183 |
$491.90 |
| 90480 |
|
42 |
42 |
$481.25 |
| 0012A |
|
561 |
557 |
$400.00 |
| 90688 |
|
390 |
328 |
$351.98 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
26 |
25 |
$95.02 |
| 0011A |
|
252 |
250 |
$16.94 |
| 90658 |
|
16 |
16 |
$15.31 |
| 90619 |
|
395 |
384 |
$1.56 |
| 90686 |
|
127 |
125 |
$0.00 |
| 91301 |
|
784 |
777 |
$0.00 |
| 90651 |
|
379 |
372 |
$0.00 |
| 90696 |
|
16 |
15 |
$0.00 |
| 91305 |
|
42 |
40 |
$0.00 |
| 90697 |
|
143 |
143 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
124 |
124 |
$0.00 |
| 91307 |
|
171 |
169 |
$0.00 |
| 0134A |
|
39 |
39 |
$0.00 |
| 0064A |
|
19 |
19 |
$0.00 |
| 90710 |
|
216 |
212 |
$0.00 |
| 90633 |
|
342 |
337 |
$0.00 |
| 99401 |
|
592 |
558 |
$0.00 |
| 90671 |
|
344 |
334 |
$0.00 |
| 90461 |
|
154 |
89 |
$0.00 |
| 91308 |
|
144 |
136 |
$0.00 |
| 90734 |
|
114 |
108 |
$0.00 |
| 90700 |
|
14 |
14 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |
| 91311 |
|
77 |
73 |
$0.00 |
| 90713 |
|
13 |
13 |
$0.00 |
| 0124A |
|
26 |
26 |
$0.00 |