| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0120 |
Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems |
23,209 |
3,079 |
$528K |
| 99199 |
Unlisted special service, procedure or report |
92,524 |
70,572 |
$504K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,424 |
2,769 |
$236K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,135 |
1,659 |
$202K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,591 |
1,243 |
$16K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
387 |
296 |
$9K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
86 |
63 |
$7K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
862 |
662 |
$6K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
363 |
288 |
$6K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
47 |
38 |
$3K |
| A0130 |
Non-emergency transportation: wheelchair van |
99 |
12 |
$3K |
| 36415 |
Collection of venous blood by venipuncture |
1,183 |
843 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
29 |
26 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
16 |
13 |
$1K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
14 |
12 |
$1K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
80 |
40 |
$774.18 |
| 99173 |
|
831 |
654 |
$449.06 |
| 87210 |
|
204 |
156 |
$154.10 |
| 90686 |
|
69 |
55 |
$151.53 |
| 96160 |
|
63 |
39 |
$100.98 |
| 81025 |
|
13 |
12 |
$96.48 |
| 83986 |
|
189 |
145 |
$89.05 |
| 82120 |
|
197 |
151 |
$84.67 |
| 90688 |
|
80 |
49 |
$31.60 |
| 81003 |
|
13 |
13 |
$17.16 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
132 |
102 |
$0.00 |
| 90734 |
|
39 |
19 |
$0.00 |
| U0001 |
Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel |
36 |
24 |
$0.00 |
| 90670 |
|
14 |
14 |
$0.00 |
| 99071 |
|
32 |
15 |
$0.00 |
| 90715 |
|
29 |
13 |
$0.00 |
| 99000 |
|
3,065 |
2,303 |
$0.00 |
| 92558 |
|
175 |
141 |
$0.00 |
| 3008F |
|
272 |
240 |
$0.00 |
| 36416 |
|
19 |
12 |
$0.00 |
| AO120 |
|
191 |
36 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
143 |
115 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
58 |
43 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
16 |
12 |
$0.00 |