| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2023 |
Targeted case management; per month |
4,914 |
3,600 |
$2.64M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
177 |
168 |
$16K |
| 99215 |
Prolong outpt/office vis |
87 |
81 |
$11K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
276 |
263 |
$6K |
| 99233 |
Prolong inpt eval add15 m |
28 |
13 |
$2K |
| 92015 |
Determination of refractive state |
124 |
118 |
$891.00 |
| 90734 |
|
27 |
27 |
$845.81 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$750.57 |
| 82728 |
|
51 |
50 |
$561.05 |
| 90686 |
|
42 |
40 |
$543.69 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
21 |
20 |
$425.04 |
| 86780 |
|
20 |
20 |
$222.40 |
| 85027 |
|
56 |
56 |
$218.40 |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
55 |
55 |
$0.00 |