| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
2,280 |
1,194 |
$222K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,541 |
3,788 |
$100K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,716 |
2,280 |
$72K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
385 |
328 |
$5K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
607 |
414 |
$5K |
| 3008F |
|
2,545 |
2,133 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
124 |
103 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
96 |
86 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
50 |
48 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
388 |
302 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
43 |
43 |
$2K |
| 36415 |
Collection of venous blood by venipuncture |
2,015 |
1,662 |
$2K |
| 90688 |
|
102 |
89 |
$1K |
| 90658 |
|
148 |
127 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
114 |
73 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
29 |
26 |
$671.58 |
| 3074F |
|
302 |
239 |
$475.00 |
| G9004 |
Coordinated care fee, risk adjusted low, initial |
1,493 |
779 |
$404.15 |
| 81003 |
|
426 |
338 |
$355.97 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
509 |
427 |
$337.02 |
| 3079F |
|
197 |
157 |
$310.00 |
| 3078F |
|
172 |
132 |
$210.00 |
| 3077F |
|
77 |
57 |
$140.00 |
| G0405 |
Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination |
33 |
27 |
$108.91 |
| 92551 |
|
32 |
29 |
$105.67 |
| 99173 |
|
38 |
31 |
$100.35 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
107 |
85 |
$47.59 |
| 82962 |
|
40 |
29 |
$41.22 |
| 3075F |
|
31 |
25 |
$40.00 |
| 3080F |
|
17 |
12 |
$40.00 |
| 80061 |
Lipid panel |
147 |
114 |
$23.98 |
| 36416 |
|
25 |
17 |
$20.49 |
| 81002 |
|
25 |
22 |
$18.90 |
| 99000 |
|
1,472 |
1,178 |
$4.32 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
31 |
27 |
$2.69 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
27 |
25 |
$0.24 |
| G9005 |
Coordinated care fee, risk adjusted maintenance |
758 |
342 |
$0.03 |
| G9007 |
Coordinated care fee, scheduled team conference |
23 |
12 |
$0.02 |
| G9006 |
Coordinated care fee, home monitoring |
127 |
79 |
$0.02 |
| G9010 |
Coordinated care fee, risk adjusted maintenance, level 4 |
109 |
58 |
$0.02 |
| 80053 |
Comprehensive metabolic panel |
263 |
219 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
165 |
135 |
$0.00 |
| 4010F |
|
103 |
81 |
$0.00 |
| 85027 |
|
31 |
28 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
164 |
124 |
$0.00 |
| 4274F |
|
86 |
71 |
$0.00 |
| G9011 |
Coordinated care fee, risk adjusted maintenance, level 5 |
132 |
84 |
$0.00 |
| 90734 |
|
17 |
16 |
$0.00 |
| 4013F |
|
164 |
125 |
$0.00 |
| 2022F |
|
13 |
13 |
$0.00 |
| 90715 |
|
15 |
14 |
$0.00 |
| 90649 |
|
21 |
20 |
$0.00 |
| 90461 |
|
13 |
12 |
$0.00 |