| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,821 |
5,642 |
$201K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,891 |
2,003 |
$62K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,426 |
1,251 |
$58K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
962 |
921 |
$53K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
698 |
681 |
$49K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
797 |
780 |
$43K |
| 76818 |
|
455 |
218 |
$34K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
493 |
471 |
$34K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
610 |
388 |
$28K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
409 |
348 |
$26K |
| 76820 |
|
734 |
361 |
$19K |
| 87428 |
|
423 |
404 |
$13K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
136 |
127 |
$11K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
584 |
568 |
$8K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
129 |
97 |
$8K |
| 99215 |
Prolong outpt/office vis |
177 |
147 |
$7K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,049 |
739 |
$7K |
| 81000 |
|
2,392 |
1,875 |
$7K |
| 59025 |
Fetal non-stress test |
185 |
136 |
$5K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
80 |
79 |
$4K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
330 |
309 |
$3K |
| 99381 |
|
42 |
41 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
115 |
113 |
$2K |
| 83655 |
|
210 |
204 |
$2K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
107 |
56 |
$2K |
| 59430 |
|
19 |
18 |
$2K |
| 99235 |
|
14 |
12 |
$2K |
| 92588 |
|
64 |
62 |
$1K |
| 30802 |
|
12 |
12 |
$1K |
| 76801 |
|
31 |
30 |
$1K |
| 99236 |
Prolong inpt eval add15 m |
13 |
13 |
$1K |
| 99460 |
|
13 |
13 |
$1K |
| 92567 |
|
74 |
71 |
$726.23 |
| 92550 |
|
29 |
29 |
$497.03 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
34 |
34 |
$424.95 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
26 |
13 |
$333.60 |
| 90461 |
|
1,451 |
1,155 |
$231.15 |
| 87807 |
|
20 |
20 |
$220.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
124 |
124 |
$137.71 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
106 |
101 |
$111.21 |
| 96160 |
|
77 |
77 |
$93.33 |
| 85018 |
|
32 |
28 |
$27.86 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
37 |
27 |
$4.16 |
| 90677 |
|
348 |
339 |
$0.54 |
| 90658 |
|
73 |
73 |
$0.04 |
| 90656 |
|
35 |
35 |
$0.02 |
| 90686 |
|
555 |
504 |
$0.01 |
| 90651 |
|
125 |
124 |
$0.01 |
| 90670 |
|
366 |
348 |
$0.00 |
| 90648 |
|
488 |
469 |
$0.00 |
| 90633 |
|
269 |
256 |
$0.00 |
| 90710 |
|
61 |
60 |
$0.00 |
| 90681 |
|
198 |
192 |
$0.00 |
| 90700 |
|
28 |
28 |
$0.00 |
| 90621 |
|
12 |
12 |
$0.00 |
| 90734 |
|
88 |
84 |
$0.00 |
| 90715 |
|
19 |
19 |
$0.00 |
| 90723 |
|
303 |
291 |
$0.00 |
| 90698 |
|
39 |
38 |
$0.00 |
| 90696 |
|
58 |
58 |
$0.00 |
| 97169 |
|
12 |
12 |
$0.00 |
| 92587 |
|
12 |
12 |
$0.00 |