| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,987 |
1,901 |
$77K |
| 90632 |
|
734 |
686 |
$41K |
| 90461 |
|
665 |
635 |
$39K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,358 |
1,254 |
$28K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
601 |
489 |
$20K |
| 90686 |
|
819 |
773 |
$7K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
150 |
120 |
$6K |
| 90651 |
|
420 |
397 |
$5K |
| D1206 |
Topical application of fluoride varnish |
321 |
264 |
$5K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
134 |
102 |
$2K |
| 86580 |
|
159 |
112 |
$1K |
| 90633 |
|
802 |
775 |
$878.00 |
| 90734 |
|
320 |
312 |
$784.80 |
| 90715 |
|
179 |
173 |
$712.64 |
| 0001A |
|
17 |
17 |
$680.00 |
| 0012A |
|
18 |
17 |
$640.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
40 |
38 |
$633.88 |
| 0002A |
|
14 |
14 |
$560.00 |
| 90656 |
|
44 |
42 |
$515.20 |
| 0011A |
|
16 |
16 |
$484.70 |
| 0064A |
|
27 |
12 |
$440.00 |
| 92551 |
|
18 |
14 |
$146.44 |
| 90670 |
|
45 |
44 |
$132.10 |
| 90674 |
|
14 |
14 |
$48.10 |
| 81025 |
|
32 |
26 |
$45.17 |
| 91322 |
|
16 |
13 |
$40.00 |
| 99173 |
|
16 |
12 |
$30.24 |
| 90710 |
|
24 |
21 |
$18.40 |
| 90696 |
|
19 |
16 |
$18.40 |
| 91301 |
|
24 |
24 |
$0.00 |