| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,022 |
917 |
$31K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
816 |
807 |
$25K |
| 90461 |
|
360 |
354 |
$19K |
| D1206 |
Topical application of fluoride varnish |
921 |
700 |
$13K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
328 |
301 |
$6K |
| 0012A |
|
176 |
163 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
64 |
62 |
$4K |
| 0011A |
|
182 |
172 |
$3K |
| 86580 |
|
414 |
361 |
$3K |
| 0002A |
|
70 |
65 |
$2K |
| 0001A |
|
59 |
56 |
$2K |
| 90633 |
|
572 |
566 |
$2K |
| 0064A |
|
65 |
40 |
$1K |
| 90651 |
|
50 |
50 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
41 |
40 |
$866.16 |
| 0134A |
|
23 |
23 |
$800.00 |
| 90632 |
|
13 |
13 |
$743.89 |
| 99201 |
|
18 |
18 |
$637.76 |
| 90734 |
|
31 |
30 |
$446.80 |
| 0031A |
|
12 |
12 |
$440.00 |
| 0013A |
|
15 |
15 |
$400.00 |
| 90686 |
|
46 |
46 |
$331.20 |
| 92551 |
|
27 |
27 |
$261.50 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$206.97 |
| 90715 |
|
15 |
14 |
$92.00 |
| 99173 |
|
28 |
28 |
$63.00 |
| 90710 |
|
14 |
14 |
$18.40 |
| 91301 |
|
126 |
120 |
$0.00 |