| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G9002 |
Coordinated care fee, maintenance rate |
4,035 |
3,670 |
$440K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,396 |
2,291 |
$34K |
| 90686 |
|
1,104 |
1,079 |
$13K |
| 90715 |
|
141 |
138 |
$2K |
| 81025 |
|
203 |
189 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
110 |
105 |
$1K |
| G9001 |
Coordinated care fee, initial rate |
46 |
43 |
$1K |
| 90734 |
|
87 |
87 |
$993.36 |
| 90619 |
|
67 |
65 |
$794.64 |
| 90656 |
|
74 |
74 |
$781.90 |
| 90651 |
|
70 |
68 |
$738.44 |
| S0215 |
Non-emergency transportation; mileage, per mile |
354 |
324 |
$719.86 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
44 |
41 |
$716.95 |
| 85018 |
|
177 |
175 |
$430.14 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
45 |
45 |
$318.25 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
157 |
147 |
$283.15 |
| 90633 |
|
19 |
12 |
$149.94 |
| 96161 |
|
92 |
72 |
$143.52 |
| 99000 |
|
143 |
136 |
$84.38 |
| 96160 |
|
13 |
13 |
$49.60 |