| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90632 |
|
779 |
774 |
$45K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
597 |
587 |
$20K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
817 |
812 |
$17K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
282 |
260 |
$17K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
253 |
228 |
$9K |
| 0011A |
|
507 |
494 |
$9K |
| 90461 |
|
93 |
88 |
$6K |
| 0012A |
|
363 |
359 |
$6K |
| 0031A |
|
172 |
170 |
$4K |
| 99201 |
|
72 |
69 |
$3K |
| 97802 |
|
70 |
52 |
$2K |
| 0001A |
|
31 |
31 |
$1K |
| 99442 |
|
57 |
40 |
$798.09 |
| 0064A |
|
66 |
58 |
$760.00 |
| 90633 |
|
451 |
442 |
$757.70 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
40 |
31 |
$644.52 |
| 0002A |
|
17 |
17 |
$640.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
13 |
12 |
$555.48 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
13 |
12 |
$555.48 |
| 90734 |
|
112 |
105 |
$493.60 |
| 0071A |
|
12 |
12 |
$480.00 |
| 0034A |
|
14 |
13 |
$360.00 |
| 81025 |
|
153 |
145 |
$246.50 |
| 86580 |
|
38 |
29 |
$226.56 |
| 90651 |
|
42 |
42 |
$147.20 |
| 90686 |
|
14 |
14 |
$111.41 |
| A4267 |
Contraceptive supply, condom, male, each |
25 |
25 |
$62.50 |
| 90696 |
|
13 |
13 |
$36.80 |
| 90710 |
|
12 |
12 |
$36.80 |
| 90715 |
|
12 |
12 |
$18.40 |
| 90662 |
|
13 |
13 |
$18.40 |
| 91301 |
|
89 |
87 |
$0.01 |