| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 95004 |
Percutaneous tests with allergenic extracts, immediate type reaction |
716 |
711 |
$293K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,652 |
5,140 |
$270K |
| 95165 |
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, multiple dose vials |
975 |
852 |
$262K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,579 |
4,202 |
$149K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,298 |
1,290 |
$97K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,362 |
1,348 |
$97K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
748 |
743 |
$59K |
| 99050 |
|
3,873 |
3,522 |
$56K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
717 |
709 |
$49K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
5,984 |
5,324 |
$45K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,746 |
2,540 |
$44K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,554 |
2,426 |
$33K |
| 95117 |
|
2,877 |
1,279 |
$22K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
875 |
841 |
$19K |
| 17000 |
|
279 |
192 |
$14K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
232 |
229 |
$13K |
| 92551 |
|
1,467 |
1,449 |
$13K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
263 |
262 |
$10K |
| 90461 |
|
1,533 |
1,304 |
$10K |
| 95115 |
|
1,389 |
520 |
$9K |
| 99383 |
|
95 |
94 |
$7K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
508 |
246 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
973 |
833 |
$6K |
| 92567 |
|
1,046 |
861 |
$6K |
| 83655 |
|
437 |
435 |
$4K |
| 99381 |
|
59 |
59 |
$4K |
| 81003 |
|
2,056 |
1,944 |
$4K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
550 |
540 |
$3K |
| 99000 |
|
568 |
548 |
$3K |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
633 |
574 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
914 |
867 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
21 |
21 |
$2K |
| 99384 |
|
14 |
14 |
$1K |
| 99382 |
|
13 |
13 |
$1K |
| 87807 |
|
83 |
78 |
$894.61 |
| 92015 |
Determination of refractive state |
279 |
277 |
$765.16 |
| 94010 |
|
26 |
26 |
$744.38 |
| 88720 |
|
110 |
64 |
$482.20 |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
17 |
12 |
$473.20 |
| 99080 |
|
121 |
120 |
$383.40 |
| 93000 |
|
15 |
15 |
$175.97 |
| 97169 |
|
144 |
143 |
$150.00 |
| 17003 |
|
30 |
25 |
$143.10 |
| 96160 |
|
1,229 |
1,133 |
$93.61 |
| 97802 |
|
99 |
99 |
$34.36 |
| 90634 |
|
277 |
274 |
$2.22 |
| 90688 |
|
1,128 |
1,087 |
$0.03 |
| 90670 |
|
713 |
703 |
$0.01 |
| 90633 |
|
134 |
133 |
$0.01 |
| 90707 |
|
171 |
170 |
$0.01 |
| 90651 |
|
285 |
283 |
$0.01 |
| 90716 |
|
170 |
169 |
$0.01 |
| 90710 |
|
167 |
167 |
$0.00 |
| 90734 |
|
272 |
270 |
$0.00 |
| 90715 |
|
106 |
105 |
$0.00 |
| 99173 |
|
514 |
505 |
$0.00 |
| 90687 |
|
390 |
385 |
$0.00 |
| 90648 |
|
487 |
481 |
$0.00 |
| 90700 |
|
199 |
196 |
$0.00 |
| 90698 |
|
132 |
128 |
$0.00 |
| 90680 |
|
478 |
471 |
$0.00 |
| 36416 |
|
668 |
641 |
$0.00 |
| 99174 |
|
1,320 |
1,296 |
$0.00 |
| 90620 |
|
151 |
150 |
$0.00 |
| 90723 |
|
346 |
343 |
$0.00 |
| S3620 |
Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-d; phenylalanine (pku); and thyroxine, total) |
12 |
12 |
$0.00 |
| 90696 |
|
179 |
179 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
74 |
74 |
$0.00 |
| 90647 |
|
39 |
38 |
$0.00 |
| 96127 |
|
24 |
24 |
$0.00 |