| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
16,954 |
10,581 |
$2.08M |
| H2020 |
Therapeutic behavioral services, per diem |
1,534 |
1,036 |
$189K |
| 0002A |
|
429 |
110 |
$2K |
| 0001A |
|
465 |
111 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,374 |
1,166 |
$960.00 |
| 0012A |
|
115 |
48 |
$482.04 |
| 0011A |
|
87 |
27 |
$407.88 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
5,081 |
3,905 |
$339.83 |
| 92551 |
|
1,621 |
1,399 |
$195.00 |
| 99173 |
|
1,697 |
1,435 |
$165.00 |
| J8499 |
Prescription drug, oral, non chemotherapeutic, nos |
3,407 |
2,198 |
$113.54 |
| 90832 |
Psychotherapy, 30 minutes with patient |
1,867 |
1,334 |
$84.26 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
2,378 |
1,260 |
$82.76 |
| 81002 |
|
1,823 |
1,389 |
$57.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
712 |
428 |
$49.00 |
| 85018 |
|
2,100 |
1,595 |
$20.00 |
| J3490 |
Unclassified drugs |
287 |
237 |
$9.84 |
| 1160F |
|
2,838 |
1,920 |
$0.00 |
| A9273 |
Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type |
480 |
412 |
$0.00 |
| 90461 |
|
19 |
17 |
$0.00 |
| 99188 |
|
211 |
162 |
$0.00 |
| 90734 |
|
84 |
79 |
$0.00 |
| 90633 |
|
239 |
206 |
$0.00 |
| 86703 |
|
667 |
416 |
$0.00 |
| 3078F |
|
4,319 |
2,930 |
$0.00 |
| 96160 |
|
259 |
199 |
$0.00 |
| 81025 |
|
145 |
114 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
188 |
147 |
$0.00 |
| 91300 |
|
1,267 |
279 |
$0.00 |
| 81003 |
|
94 |
77 |
$0.00 |
| 1159F |
|
2,838 |
1,920 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
42 |
38 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
54 |
49 |
$0.00 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
192 |
61 |
$0.00 |
| 99177 |
|
27 |
13 |
$0.00 |
| 1036F |
|
11,962 |
7,146 |
$0.00 |
| 3008F |
|
8,828 |
5,835 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
9,592 |
6,905 |
$0.00 |
| 3074F |
|
4,407 |
2,970 |
$0.00 |
| 1035F |
|
192 |
125 |
$0.00 |
| 1126F |
|
1,382 |
1,088 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,172 |
4,839 |
$0.00 |
| 96127 |
|
10,053 |
6,608 |
$0.00 |
| 1000F |
|
8,285 |
5,858 |
$0.00 |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
84 |
79 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
800 |
677 |
$0.00 |
| 99000 |
|
2,506 |
1,440 |
$0.00 |
| 1125F |
|
3,101 |
2,213 |
$0.00 |
| A6448 |
Light compression bandage, elastic, knitted/woven, width less than three inches, per yard |
83 |
66 |
$0.00 |
| 90651 |
|
122 |
109 |
$0.00 |
| 99384 |
|
26 |
24 |
$0.00 |
| 90686 |
|
48 |
42 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
62 |
56 |
$0.00 |
| Q0162 |
Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
15 |
14 |
$0.00 |
| 91301 |
|
279 |
101 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
72 |
64 |
$0.00 |
| A9150 |
Non-prescription drugs |
58 |
43 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
20 |
12 |
$0.00 |
| 3079F |
|
32 |
25 |
$0.00 |
| 1034F |
|
42 |
41 |
$0.00 |