| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
7,728 |
5,043 |
$219K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
932 |
775 |
$27K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
584 |
435 |
$14K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,441 |
603 |
$12K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
1,807 |
1,183 |
$11K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,119 |
914 |
$9K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
112 |
92 |
$5K |
| 99215 |
Prolong outpt/office vis |
109 |
72 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
202 |
72 |
$4K |
| 81000 |
|
1,314 |
923 |
$2K |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
409 |
290 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$904.02 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
16 |
12 |
$520.00 |
| 96127 |
|
63 |
41 |
$452.86 |
| 92551 |
|
49 |
40 |
$390.70 |
| 93000 |
|
37 |
28 |
$265.84 |
| 99173 |
|
64 |
53 |
$258.09 |
| 90674 |
|
23 |
16 |
$175.39 |
| 1160F |
|
449 |
313 |
$120.00 |
| 3008F |
|
610 |
440 |
$90.01 |
| 1159F |
|
429 |
272 |
$90.00 |
| 3074F |
|
209 |
158 |
$80.00 |
| 3078F |
|
184 |
135 |
$60.00 |
| 90688 |
|
18 |
12 |
$42.20 |
| 3079F |
|
47 |
34 |
$30.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
15 |
13 |
$24.03 |
| G0008 |
Administration of influenza virus vaccine |
36 |
26 |
$14.09 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
16 |
12 |
$12.47 |
| 91301 |
|
21 |
12 |
$0.07 |
| 1158F |
|
23 |
13 |
$0.00 |
| 99499 |
|
28 |
28 |
$0.00 |
| 1036F |
|
314 |
232 |
$0.00 |
| 1125F |
|
54 |
31 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
28 |
12 |
$0.00 |
| 1170F |
|
68 |
36 |
$0.00 |