| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
193 |
187 |
$5K |
| 86703 |
|
614 |
591 |
$3K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
40 |
40 |
$3K |
| 86592 |
|
895 |
848 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
235 |
225 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
44 |
43 |
$1K |
| 87210 |
|
310 |
303 |
$1K |
| A9150 |
Non-prescription drugs |
88 |
87 |
$1K |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
67 |
67 |
$576.48 |
| 81025 |
|
57 |
54 |
$289.27 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
433 |
146 |
$272.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
227 |
188 |
$160.00 |
| 88164 |
|
12 |
12 |
$138.60 |
| 90715 |
|
55 |
45 |
$0.00 |
| 90633 |
|
14 |
12 |
$0.00 |
| 90713 |
|
16 |
16 |
$0.00 |
| 90651 |
|
50 |
46 |
$0.00 |
| 90619 |
|
33 |
31 |
$0.00 |
| 90686 |
|
16 |
14 |
$0.00 |