| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,548 |
3,251 |
$127K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
6,382 |
5,877 |
$99K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,578 |
3,336 |
$61K |
| 90716 |
|
931 |
870 |
$48K |
| 90651 |
|
1,880 |
1,760 |
$29K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
509 |
462 |
$28K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
559 |
533 |
$22K |
| 90715 |
|
2,226 |
2,074 |
$22K |
| 90739 |
|
168 |
154 |
$21K |
| 90686 |
|
1,797 |
1,719 |
$19K |
| 90734 |
|
2,566 |
2,417 |
$16K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
428 |
410 |
$15K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
280 |
267 |
$14K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
205 |
176 |
$14K |
| 90707 |
|
311 |
293 |
$10K |
| 90633 |
|
1,873 |
1,778 |
$10K |
| 86580 |
|
1,927 |
1,492 |
$10K |
| 91320 |
|
122 |
102 |
$9K |
| 36415 |
Collection of venous blood by venipuncture |
3,474 |
3,228 |
$8K |
| 90648 |
|
1,180 |
1,150 |
$7K |
| 90670 |
|
1,096 |
1,086 |
$7K |
| 90723 |
|
914 |
893 |
$5K |
| 90710 |
|
1,002 |
944 |
$5K |
| 90662 |
|
211 |
192 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
82 |
80 |
$4K |
| 83655 |
|
331 |
320 |
$3K |
| 87205 |
|
1,032 |
974 |
$3K |
| 92015 |
Determination of refractive state |
225 |
210 |
$3K |
| 90480 |
|
100 |
100 |
$3K |
| 87210 |
|
677 |
621 |
$2K |
| 90746 |
|
34 |
34 |
$2K |
| 90696 |
|
414 |
390 |
$2K |
| 90680 |
|
313 |
311 |
$2K |
| 90713 |
|
360 |
329 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
80 |
75 |
$2K |
| 90620 |
|
172 |
165 |
$1K |
| 90700 |
|
302 |
285 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
78 |
73 |
$885.98 |
| 86703 |
|
76 |
71 |
$762.48 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
84 |
68 |
$739.46 |
| 86803 |
|
53 |
53 |
$662.22 |
| 90632 |
|
16 |
16 |
$662.20 |
| 36416 |
|
202 |
191 |
$357.87 |
| 99401 |
|
15 |
15 |
$337.24 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$308.07 |
| V2020 |
Frames, purchases |
59 |
59 |
$279.45 |
| D1351 |
Sealant - per tooth |
993 |
302 |
$198.00 |
| 90671 |
|
38 |
23 |
$190.00 |
| G0008 |
Administration of influenza virus vaccine |
190 |
177 |
$150.00 |
| 81025 |
|
17 |
12 |
$77.84 |
| T1015 |
Clinic visit/encounter, all-inclusive |
351 |
341 |
$0.00 |
| 90461 |
|
30 |
24 |
$0.00 |
| 90744 |
|
16 |
12 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
47 |
47 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$0.00 |