| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 54150 |
|
631 |
509 |
$100K |
| 59410 |
|
86 |
45 |
$55K |
| 76801 |
|
282 |
178 |
$18K |
| 81025 |
|
858 |
534 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
45 |
31 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
144 |
78 |
$1K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
13 |
13 |
$1K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
17 |
13 |
$873.16 |
| 90686 |
|
40 |
35 |
$730.43 |
| 90715 |
|
33 |
13 |
$315.68 |
| 0500F |
|
630 |
434 |
$280.00 |
| 81001 |
|
787 |
498 |
$228.39 |
| 36415 |
Collection of venous blood by venipuncture |
176 |
64 |
$170.56 |
| 81003 |
|
244 |
206 |
$39.66 |
| 81002 |
|
332 |
172 |
$24.98 |
| 99000 |
|
1,003 |
600 |
$0.00 |
| 3292F |
|
378 |
240 |
$0.00 |
| 3294F |
|
279 |
168 |
$0.00 |
| 0502F |
|
811 |
536 |
$0.00 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
14 |
14 |
$0.00 |