| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
271 |
149 |
$39K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
92 |
92 |
$4K |
| 81025 |
|
256 |
127 |
$788.75 |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
29 |
27 |
$323.90 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
62 |
48 |
$247.20 |
| 87210 |
|
47 |
24 |
$97.52 |
| S4993 |
Contraceptive pills for birth control |
12 |
12 |
$63.45 |
| 90688 |
|
49 |
49 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
585 |
583 |
$0.00 |
| 90651 |
|
118 |
118 |
$0.00 |
| 90686 |
|
108 |
108 |
$0.00 |
| 90723 |
|
13 |
13 |
$0.00 |
| 90716 |
|
13 |
13 |
$0.00 |
| 90744 |
|
15 |
15 |
$0.00 |
| 90620 |
|
13 |
13 |
$0.00 |
| 90680 |
|
15 |
15 |
$0.00 |
| 90698 |
|
28 |
28 |
$0.00 |
| 90647 |
|
17 |
17 |
$0.00 |
| 90633 |
|
102 |
102 |
$0.00 |
| 90715 |
|
49 |
49 |
$0.00 |
| 90734 |
|
127 |
127 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
376 |
376 |
$0.00 |
| 90700 |
|
16 |
16 |
$0.00 |
| 90710 |
|
43 |
43 |
$0.00 |
| 90670 |
|
101 |
101 |
$0.00 |