| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90472 |
Immunization administration, each additional vaccine (list separately) |
6,459 |
6,443 |
$254K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
10,874 |
10,829 |
$212K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,360 |
1,310 |
$26K |
| 86481 |
|
250 |
250 |
$22K |
| 90716 |
|
328 |
328 |
$13K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
176 |
176 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
54 |
54 |
$5K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
174 |
174 |
$5K |
| 90715 |
|
1,261 |
1,261 |
$4K |
| 90746 |
|
69 |
67 |
$4K |
| 90651 |
|
415 |
413 |
$3K |
| 81025 |
|
415 |
413 |
$3K |
| 86580 |
|
338 |
315 |
$3K |
| 90686 |
|
848 |
848 |
$3K |
| 90707 |
|
150 |
150 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$2K |
| 90480 |
|
32 |
32 |
$1K |
| 90633 |
|
456 |
456 |
$932.21 |
| 90620 |
|
30 |
29 |
$850.00 |
| T1001 |
Nursing assessment / evaluation |
24 |
24 |
$802.14 |
| 36415 |
Collection of venous blood by venipuncture |
189 |
188 |
$516.12 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
17 |
17 |
$516.00 |
| 88141 |
|
29 |
29 |
$348.00 |
| 86592 |
|
86 |
86 |
$326.80 |
| 90714 |
|
13 |
13 |
$283.10 |
| 90619 |
|
204 |
204 |
$282.00 |
| 90734 |
|
534 |
534 |
$273.37 |
| 86701 |
|
58 |
58 |
$233.00 |
| 90713 |
|
494 |
494 |
$193.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
14 |
$176.54 |
| 90670 |
|
366 |
366 |
$174.00 |
| 87210 |
|
24 |
24 |
$124.32 |
| 90674 |
|
231 |
231 |
$90.00 |
| 90634 |
|
522 |
522 |
$34.18 |
| 90744 |
|
256 |
256 |
$25.29 |
| 86308 |
|
40 |
40 |
$0.40 |
| 91320 |
|
36 |
36 |
$0.19 |
| 90710 |
|
678 |
678 |
$0.00 |
| 90700 |
|
258 |
258 |
$0.00 |
| 90648 |
|
38 |
38 |
$0.00 |
| 90696 |
|
249 |
249 |
$0.00 |
| 90723 |
|
137 |
137 |
$0.00 |
| 91318 |
|
17 |
17 |
$0.00 |
| 91319 |
|
22 |
22 |
$0.00 |