| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0064A |
|
508 |
441 |
$23K |
| 0011A |
|
542 |
534 |
$17K |
| 0012A |
|
480 |
473 |
$11K |
| 0001A |
|
126 |
126 |
$10K |
| 0071A |
|
87 |
85 |
$8K |
| 0031A |
|
71 |
69 |
$6K |
| 91322 |
|
66 |
66 |
$6K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
247 |
237 |
$6K |
| 0002A |
|
70 |
69 |
$4K |
| 0072A |
|
41 |
40 |
$3K |
| 0134A |
|
80 |
73 |
$2K |
| 90480 |
|
66 |
66 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
113 |
108 |
$1K |
| 0051A |
|
12 |
12 |
$1K |
| 90686 |
|
58 |
55 |
$894.96 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$437.98 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
16 |
15 |
$414.93 |
| 0054A |
|
38 |
36 |
$400.00 |
| 0013A |
|
14 |
14 |
$273.46 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
14 |
13 |
$138.20 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
14 |
13 |
$138.20 |
| 36415 |
Collection of venous blood by venipuncture |
13 |
13 |
$30.24 |
| 91301 |
|
1,631 |
1,538 |
$9.52 |
| 91300 |
|
437 |
408 |
$2.88 |
| 91303 |
|
90 |
89 |
$0.72 |
| 91313 |
|
79 |
72 |
$0.38 |
| 91305 |
|
34 |
32 |
$0.16 |
| 90461 |
|
13 |
12 |
$0.00 |