| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,504 |
5,005 |
$229K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,557 |
2,403 |
$162K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,189 |
3,850 |
$135K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,309 |
1,274 |
$75K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,332 |
1,281 |
$69K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
962 |
948 |
$55K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
600 |
587 |
$38K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,284 |
668 |
$15K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,040 |
1,011 |
$13K |
| 90633 |
|
445 |
431 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
171 |
167 |
$3K |
| 85018 |
|
585 |
573 |
$1K |
| 99381 |
|
20 |
14 |
$934.67 |
| 90670 |
|
1,083 |
1,045 |
$658.75 |
| 90698 |
|
745 |
719 |
$521.50 |
| 90680 |
|
612 |
595 |
$461.50 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
27 |
25 |
$395.25 |
| 90686 |
|
1,025 |
1,009 |
$384.62 |
| 90651 |
|
191 |
182 |
$328.08 |
| 90744 |
|
363 |
347 |
$320.25 |
| 81002 |
|
99 |
94 |
$210.30 |
| 87807 |
|
12 |
12 |
$153.45 |
| 90734 |
|
191 |
186 |
$98.75 |
| 90700 |
|
114 |
108 |
$90.00 |
| 90685 |
|
142 |
136 |
$50.00 |
| 90710 |
|
39 |
37 |
$35.75 |
| 90715 |
|
64 |
62 |
$31.50 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
14 |
13 |
$27.12 |
| 90713 |
|
29 |
28 |
$20.00 |
| 90716 |
|
24 |
24 |
$20.00 |
| 90696 |
|
30 |
30 |
$20.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
13 |
12 |
$0.78 |
| 90621 |
|
16 |
15 |
$0.00 |
| 90672 |
|
21 |
20 |
$0.00 |
| 94760 |
|
15 |
13 |
$0.00 |