| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,680 |
1,483 |
$320K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
562 |
488 |
$97K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
298 |
280 |
$51K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
70 |
67 |
$16K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
88 |
86 |
$16K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
50 |
49 |
$9K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
31 |
31 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
752 |
700 |
$743.05 |
| 90686 |
|
243 |
224 |
$738.65 |
| 90715 |
|
16 |
13 |
$219.36 |
| 92551 |
|
182 |
163 |
$195.20 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
37 |
37 |
$195.20 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
429 |
269 |
$169.00 |
| 90480 |
|
17 |
16 |
$123.54 |
| 81025 |
|
37 |
29 |
$23.25 |
| 87400 |
|
41 |
34 |
$19.78 |
| 81003 |
|
149 |
106 |
$6.99 |
| 99173 |
|
171 |
154 |
$0.00 |
| 3078F |
|
339 |
299 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
38 |
33 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
83 |
69 |
$0.00 |
| 91320 |
|
12 |
12 |
$0.00 |
| 3008F |
|
2,207 |
1,955 |
$0.00 |
| 3074F |
|
424 |
369 |
$0.00 |
| 85018 |
|
46 |
44 |
$0.00 |
| 87428 |
|
63 |
61 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,158 |
1,043 |
$0.00 |
| 36416 |
|
203 |
188 |
$0.00 |
| 3079F |
|
110 |
98 |
$0.00 |
| 87430 |
|
32 |
32 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
53 |
53 |
$0.00 |
| 1000F |
|
179 |
144 |
$0.00 |
| 3075F |
|
12 |
12 |
$0.00 |
| 87280 |
|
14 |
14 |
$0.00 |