| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,025 |
3,990 |
$154K |
| 90461 |
|
1,726 |
1,717 |
$110K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
210 |
199 |
$8K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
106 |
104 |
$5K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
106 |
104 |
$5K |
| 90632 |
|
44 |
44 |
$3K |
| 90633 |
|
1,027 |
1,020 |
$2K |
| 90734 |
|
514 |
508 |
$2K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
27 |
26 |
$1K |
| 90686 |
|
351 |
348 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
43 |
41 |
$904.40 |
| 90651 |
|
601 |
594 |
$667.30 |
| 90619 |
|
13 |
12 |
$574.00 |
| 90670 |
|
693 |
685 |
$555.30 |
| 90688 |
|
290 |
287 |
$404.80 |
| 90698 |
|
291 |
287 |
$352.90 |
| 90715 |
|
157 |
152 |
$219.64 |
| 90685 |
|
47 |
47 |
$202.40 |
| 90710 |
|
60 |
60 |
$128.80 |
| 90696 |
|
58 |
58 |
$128.80 |
| 90744 |
|
71 |
69 |
$80.20 |
| A4267 |
Contraceptive supply, condom, male, each |
25 |
25 |
$69.00 |
| 90700 |
|
12 |
12 |
$55.20 |
| 90649 |
|
15 |
15 |
$0.00 |
| 90733 |
|
16 |
16 |
$0.00 |