| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V5008 |
Hearing screening |
10,551 |
10,442 |
$99K |
| 99172 |
|
9,118 |
8,989 |
$85K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,250 |
3,234 |
$66K |
| 83655 |
|
3,756 |
3,730 |
$48K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,614 |
4,577 |
$44K |
| 90651 |
|
539 |
535 |
$10K |
| 99402 |
|
103 |
86 |
$7K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
616 |
602 |
$5K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
581 |
568 |
$3K |
| 90632 |
|
59 |
58 |
$3K |
| 90715 |
|
475 |
474 |
$2K |
| D1206 |
Topical application of fluoride varnish |
101 |
101 |
$2K |
| 90480 |
|
65 |
65 |
$2K |
| D0191 |
|
151 |
151 |
$2K |
| 90688 |
|
222 |
220 |
$2K |
| 90707 |
|
137 |
136 |
$2K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
65 |
65 |
$1K |
| 91322 |
|
15 |
15 |
$1K |
| 0071A |
|
28 |
28 |
$1K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
14 |
13 |
$984.22 |
| 0072A |
|
19 |
19 |
$715.31 |
| 90746 |
|
14 |
14 |
$663.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
64 |
56 |
$642.91 |
| 90670 |
|
702 |
697 |
$625.33 |
| 90734 |
|
322 |
320 |
$601.00 |
| 90716 |
|
67 |
66 |
$400.56 |
| 90619 |
|
107 |
107 |
$306.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
13 |
$293.52 |
| 90474 |
|
82 |
79 |
$246.00 |
| S4993 |
Contraceptive pills for birth control |
49 |
42 |
$229.75 |
| A4267 |
Contraceptive supply, condom, male, each |
139 |
105 |
$113.18 |
| 90656 |
|
47 |
47 |
$111.75 |
| 90633 |
|
566 |
563 |
$0.00 |
| 90710 |
|
121 |
121 |
$0.00 |
| 90685 |
|
129 |
129 |
$0.00 |
| 90700 |
|
66 |
66 |
$0.00 |
| 90671 |
|
48 |
48 |
$0.00 |
| 87850 |
|
279 |
259 |
$0.00 |
| 90686 |
|
722 |
722 |
$0.00 |
| 87110 |
|
275 |
255 |
$0.00 |
| 90723 |
|
97 |
95 |
$0.00 |
| 90696 |
|
59 |
59 |
$0.00 |
| 87800 |
|
266 |
263 |
$0.00 |
| 90647 |
|
243 |
241 |
$0.00 |
| 90680 |
|
94 |
91 |
$0.00 |
| 90620 |
|
13 |
13 |
$0.00 |
| 90698 |
|
93 |
92 |
$0.00 |
| 90744 |
|
14 |
14 |
$0.00 |