| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
672 |
594 |
$56K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
104 |
93 |
$13K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
84 |
84 |
$10K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
67 |
67 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
59 |
59 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
45 |
45 |
$6K |
| 90461 |
|
112 |
112 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
163 |
163 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
116 |
113 |
$2K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
151 |
142 |
$1K |
| 81000 |
|
162 |
160 |
$599.43 |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
36 |
32 |
$510.12 |
| 87430 |
|
30 |
30 |
$407.30 |
| 85018 |
|
164 |
164 |
$388.68 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
37 |
34 |
$169.95 |
| 96160 |
|
17 |
17 |
$166.09 |
| 83655 |
|
12 |
12 |
$151.08 |
| 99070 |
|
13 |
12 |
$92.88 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
35 |
32 |
$87.61 |
| 90670 |
|
52 |
52 |
$0.00 |
| 90633 |
|
29 |
29 |
$0.00 |
| 90700 |
|
19 |
19 |
$0.00 |
| 92551 |
|
132 |
132 |
$0.00 |
| 94760 |
|
47 |
39 |
$0.00 |
| 90698 |
|
25 |
25 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |
| 90680 |
|
12 |
12 |
$0.00 |