| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
941 |
543 |
$16K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
114 |
107 |
$5K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
15 |
13 |
$3K |
| 80053 |
Comprehensive metabolic panel |
57 |
54 |
$28.89 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
73 |
64 |
$28.36 |
| 82728 |
|
13 |
13 |
$24.86 |
| 83540 |
|
13 |
13 |
$11.80 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
276 |
254 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16 |
16 |
$0.00 |