| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,484 |
3,131 |
$124K |
| D1120 |
Prophylaxis - child |
2,060 |
2,026 |
$119K |
| D1351 |
Sealant - per tooth |
1,251 |
1,200 |
$88K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
1,419 |
1,319 |
$83K |
| D0191 |
|
3,252 |
3,035 |
$72K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
1,572 |
1,447 |
$69K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
1,575 |
1,446 |
$68K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,531 |
1,386 |
$63K |
| 90632 |
|
782 |
752 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,457 |
2,421 |
$44K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,527 |
1,421 |
$31K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,000 |
987 |
$27K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,579 |
1,398 |
$26K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
292 |
263 |
$22K |
| D1110 |
Prophylaxis - adult |
258 |
255 |
$14K |
| S4993 |
Contraceptive pills for birth control |
553 |
524 |
$14K |
| 86580 |
|
1,908 |
1,611 |
$11K |
| 83655 |
|
570 |
563 |
$10K |
| 99201 |
|
227 |
224 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
99 |
97 |
$8K |
| 90686 |
|
690 |
634 |
$8K |
| 90461 |
|
159 |
159 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
110 |
97 |
$6K |
| 90734 |
|
258 |
254 |
$6K |
| 90651 |
|
62 |
62 |
$3K |
| 90633 |
|
427 |
422 |
$3K |
| 81025 |
|
1,623 |
1,486 |
$3K |
| 0064A |
|
63 |
46 |
$2K |
| 90715 |
|
129 |
121 |
$1K |
| 0012A |
|
46 |
45 |
$1K |
| A4267 |
Contraceptive supply, condom, male, each |
750 |
697 |
$949.05 |
| 90656 |
|
34 |
33 |
$386.50 |
| 90716 |
|
13 |
13 |
$298.68 |
| 99173 |
|
95 |
95 |
$204.12 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
15 |
12 |
$138.49 |
| 86592 |
|
24 |
24 |
$116.09 |
| 36416 |
|
12 |
12 |
$12.00 |
| 36415 |
Collection of venous blood by venipuncture |
12 |
12 |
$6.00 |
| D1330 |
|
1,289 |
1,274 |
$0.00 |
| D0601 |
|
167 |
166 |
$0.00 |
| D0603 |
|
899 |
887 |
$0.00 |
| D1310 |
|
1,237 |
1,222 |
$0.00 |
| D1320 |
|
257 |
255 |
$0.00 |
| D0602 |
|
86 |
86 |
$0.00 |
| D1999 |
|
30 |
29 |
$0.00 |