| Code | Description | Claims | Beneficiaries | Total Paid |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
1,700 |
326 |
$54K |
| 99222 |
Initial hospital care, per day, moderate complexity |
72 |
72 |
$5K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
37 |
16 |
$566.75 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
13 |
$521.76 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
12 |
$422.92 |
| S9999 |
Sales tax |
81 |
22 |
$75.39 |