| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,875 |
1,307 |
$43K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
683 |
544 |
$27K |
| 11755 |
|
196 |
136 |
$11K |
| 73630 |
|
583 |
305 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
56 |
47 |
$3K |
| A6255 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
75 |
49 |
$37.33 |
| A4247 |
Betadine or iodine swabs/wipes, per box |
88 |
65 |
$19.60 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
86 |
62 |
$0.60 |
| A4550 |
Surgical trays |
92 |
67 |
$0.00 |