| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,304 |
2,948 |
$290K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,588 |
4,098 |
$278K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,825 |
1,639 |
$151K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,268 |
1,189 |
$107K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,946 |
2,320 |
$78K |
| 90461 |
|
1,202 |
1,065 |
$19K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
191 |
190 |
$18K |
| 92552 |
|
1,070 |
1,021 |
$14K |
| 99177 |
|
2,179 |
2,062 |
$11K |
| 94760 |
|
2,411 |
2,148 |
$4K |
| 99058 |
|
226 |
212 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
26 |
26 |
$4K |
| 99463 |
|
42 |
38 |
$3K |
| 99070 |
|
2,512 |
2,329 |
$3K |
| 96161 |
|
883 |
850 |
$2K |
| 99215 |
Prolong outpt/office vis |
14 |
13 |
$2K |
| 99381 |
|
13 |
13 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
188 |
162 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$990.00 |
| 99443 |
|
14 |
13 |
$438.96 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
84 |
76 |
$391.82 |
| 36416 |
|
12 |
12 |
$40.26 |
| 90686 |
|
471 |
445 |
$17.34 |
| 90656 |
|
65 |
65 |
$3.71 |
| 90671 |
|
178 |
174 |
$1.05 |
| 99072 |
|
1,150 |
917 |
$1.04 |
| 99000 |
|
197 |
179 |
$0.00 |
| 90723 |
|
214 |
211 |
$0.00 |
| 90647 |
|
110 |
108 |
$0.00 |
| S3620 |
Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-d; phenylalanine (pku); and thyroxine, total) |
27 |
24 |
$0.00 |
| 90680 |
|
29 |
29 |
$0.00 |
| 90698 |
|
89 |
89 |
$0.00 |
| 90744 |
|
26 |
26 |
$0.00 |
| 90716 |
|
16 |
16 |
$0.00 |
| 90670 |
|
328 |
318 |
$0.00 |
| 90633 |
|
122 |
110 |
$0.00 |
| 99173 |
|
26 |
26 |
$0.00 |
| 90710 |
|
13 |
13 |
$0.00 |
| 90681 |
|
46 |
45 |
$0.00 |
| 90707 |
|
13 |
13 |
$0.00 |