| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
18,812 |
13,415 |
$2.56M |
| A0425 |
Ground mileage, per statute mile |
21,742 |
15,648 |
$529K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
3,571 |
2,500 |
$475K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
365 |
327 |
$14K |
| A0998 |
Ambulance response and treatment, no transport |
100 |
67 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
114 |
73 |
$756.24 |
| 90716 |
|
33 |
28 |
$600.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
43 |
28 |
$395.36 |
| 81025 |
|
66 |
46 |
$343.17 |
| 90619 |
|
26 |
23 |
$260.00 |
| 90715 |
|
132 |
128 |
$223.44 |
| 90707 |
|
29 |
24 |
$180.00 |
| 86580 |
|
19 |
12 |
$37.95 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
143 |
101 |
$0.00 |
| 99000 |
|
21 |
16 |
$0.00 |
| 87797 |
|
141 |
94 |
$0.00 |
| G0472 |
Hepatitis c antibody screening, for individual at high risk and other covered indication(s) |
45 |
30 |
$0.00 |
| 86592 |
|
127 |
86 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
15 |
12 |
$0.00 |
| 90696 |
|
52 |
45 |
$0.00 |
| 90651 |
|
21 |
19 |
$0.00 |
| 90677 |
|
27 |
24 |
$0.00 |
| 90461 |
|
98 |
83 |
$0.00 |
| 90633 |
|
101 |
84 |
$0.00 |
| 90710 |
|
96 |
81 |
$0.00 |
| A4268 |
Contraceptive supply, condom, female, each |
15 |
14 |
$0.00 |
| 90713 |
|
14 |
13 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
15 |
12 |
$0.00 |