| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
666 |
587 |
$39K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
235 |
228 |
$21K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
334 |
320 |
$17K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
149 |
149 |
$14K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
109 |
107 |
$10K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
95 |
92 |
$9K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
183 |
176 |
$7K |
| 99460 |
|
72 |
71 |
$6K |
| 99381 |
|
27 |
27 |
$3K |
| 54150 |
|
17 |
16 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$1K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
63 |
56 |
$933.24 |
| A4550 |
Surgical trays |
53 |
46 |
$716.94 |
| 99462 |
|
17 |
13 |
$654.56 |
| 94760 |
|
257 |
240 |
$579.44 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
54 |
54 |
$538.51 |
| 64450 |
|
48 |
42 |
$368.34 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
29 |
29 |
$258.53 |
| 81002 |
|
165 |
158 |
$252.05 |
| 85018 |
|
95 |
91 |
$170.59 |
| 87807 |
|
15 |
15 |
$144.78 |
| 84030 |
|
30 |
29 |
$116.19 |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
48 |
42 |
$8.52 |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
165 |
158 |
$5.94 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
13 |
12 |
$4.94 |
| 99000 |
|
113 |
104 |
$0.38 |
| 90698 |
|
97 |
95 |
$0.00 |
| 90680 |
|
67 |
67 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
19 |
18 |
$0.00 |
| 90744 |
|
12 |
12 |
$0.00 |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
54 |
47 |
$0.00 |
| 90670 |
|
143 |
140 |
$0.00 |
| 99051 |
|
18 |
17 |
$0.00 |