| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0001A |
|
4,054 |
3,802 |
$145K |
| 0002A |
|
3,590 |
3,391 |
$133K |
| 0004A |
|
1,416 |
1,415 |
$49K |
| 0071A |
|
1,082 |
1,081 |
$43K |
| 0072A |
|
917 |
916 |
$36K |
| 0003A |
|
476 |
473 |
$18K |
| 0064A |
|
469 |
465 |
$15K |
| 90686 |
|
648 |
631 |
$8K |
| 0124A |
|
256 |
256 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,404 |
1,367 |
$4K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
192 |
192 |
$3K |
| 0011A |
|
86 |
86 |
$3K |
| 90715 |
|
85 |
85 |
$3K |
| 0134A |
|
88 |
88 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
55 |
55 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,411 |
1,391 |
$2K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
113 |
113 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
105 |
105 |
$1K |
| 90694 |
|
203 |
203 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
708 |
677 |
$788.84 |
| 0081A |
|
18 |
18 |
$710.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
245 |
242 |
$682.13 |
| 0031A |
|
18 |
18 |
$680.00 |
| 90656 |
|
66 |
65 |
$664.43 |
| 0073A |
|
15 |
15 |
$600.00 |
| 0034A |
|
14 |
14 |
$560.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
200 |
193 |
$551.88 |
| 0012A |
|
14 |
14 |
$520.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
15 |
15 |
$400.52 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
136 |
132 |
$286.72 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
13 |
13 |
$192.41 |
| 90688 |
|
224 |
222 |
$171.96 |
| 91320 |
|
84 |
84 |
$65.55 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
12 |
$24.51 |
| 90480 |
|
133 |
133 |
$20.00 |
| 90653 |
|
24 |
24 |
$15.41 |
| 1160F |
|
1,392 |
1,323 |
$0.00 |
| 1159F |
|
1,415 |
1,346 |
$0.00 |
| 3078F |
|
106 |
103 |
$0.00 |
| 1158F |
|
202 |
202 |
$0.00 |
| 97803 |
|
122 |
121 |
$0.00 |
| 1090F |
|
108 |
103 |
$0.00 |
| 90746 |
|
71 |
71 |
$0.00 |
| 99605 |
|
84 |
84 |
$0.00 |
| 91322 |
|
40 |
40 |
$0.00 |
| 98968 |
|
15 |
12 |
$0.00 |
| 1170F |
|
4,044 |
4,023 |
$0.00 |
| 1101F |
|
244 |
232 |
$0.00 |
| 1125F |
|
2,434 |
2,432 |
$0.00 |
| 1126F |
|
1,029 |
1,008 |
$0.00 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
99 |
95 |
$0.00 |
| 3074F |
|
68 |
63 |
$0.00 |
| 99606 |
|
49 |
49 |
$0.00 |
| 1111F |
|
44 |
44 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
28 |
28 |
$0.00 |
| 3008F |
|
12 |
12 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
97 |
97 |
$0.00 |
| 3079F |
|
25 |
24 |
$0.00 |