| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,322 |
1,123 |
$105K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
100 |
98 |
$6K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
85 |
85 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
40 |
40 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
26 |
26 |
$2K |
| 92551 |
|
145 |
145 |
$1K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
26 |
26 |
$700.18 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
26 |
26 |
$566.02 |
| 90461 |
|
12 |
12 |
$503.88 |
| 99443 |
|
16 |
16 |
$419.36 |
| 1159F |
|
27 |
26 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
27 |
27 |
$0.00 |