| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,822 |
1,306 |
$68K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,563 |
1,170 |
$36K |
| A4927 |
Gloves, non-sterile, per 100 |
1,949 |
1,453 |
$7K |
| 97803 |
|
238 |
204 |
$4K |
| 99401 |
|
256 |
234 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
452 |
418 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
26 |
24 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
57 |
51 |
$903.20 |
| 92552 |
|
34 |
27 |
$535.69 |
| 99188 |
|
27 |
26 |
$377.16 |
| 69210 |
|
16 |
13 |
$204.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
315 |
225 |
$155.80 |
| 97802 |
|
13 |
12 |
$150.53 |
| 81002 |
|
112 |
97 |
$119.45 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
336 |
299 |
$118.17 |
| 92081 |
|
14 |
12 |
$55.56 |
| 99000 |
|
952 |
653 |
$6.11 |
| 99173 |
|
30 |
14 |
$0.00 |
| A4928 |
Surgical mask, per 20 |
194 |
143 |
$0.00 |
| 99072 |
|
35 |
31 |
$0.00 |
| 98966 |
|
78 |
70 |
$0.00 |
| 94760 |
|
665 |
439 |
$0.00 |
| A7030 |
Full face mask used with positive airway pressure device, each |
26 |
14 |
$0.00 |