| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 87428 |
|
6,587 |
5,122 |
$364K |
| 99188 |
|
7,266 |
5,140 |
$89K |
| 99401 |
|
4,471 |
3,398 |
$41K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
988 |
806 |
$35K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,023 |
652 |
$16K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,329 |
1,105 |
$12K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,198 |
899 |
$10K |
| 87807 |
|
605 |
534 |
$7K |
| 90686 |
|
473 |
423 |
$6K |
| 81003 |
|
2,848 |
2,082 |
$6K |
| 83655 |
|
221 |
199 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
65 |
63 |
$3K |
| 85018 |
|
953 |
731 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
35 |
35 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
36 |
32 |
$2K |
| 81025 |
|
320 |
175 |
$1K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
274 |
209 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
68 |
63 |
$919.76 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
15 |
15 |
$915.15 |
| 90697 |
|
63 |
60 |
$880.65 |
| 90677 |
|
71 |
69 |
$867.24 |
| G0511 |
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month |
178 |
150 |
$678.12 |
| 90680 |
|
44 |
42 |
$525.60 |
| 90633 |
|
27 |
26 |
$275.94 |
| 90710 |
|
15 |
15 |
$183.96 |
| 90670 |
|
14 |
14 |
$170.82 |
| 90651 |
|
15 |
13 |
$157.68 |
| 90380 |
|
12 |
12 |
$157.68 |
| 90620 |
|
15 |
13 |
$118.26 |
| 3074F |
|
103 |
90 |
$0.00 |
| 3080F |
|
148 |
133 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
32 |
26 |
$0.00 |
| 3078F |
|
115 |
101 |
$0.00 |
| 3077F |
|
153 |
136 |
$0.00 |