| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,392 |
1,153 |
$40K |
| A0130 |
Non-emergency transportation: wheelchair van |
1,121 |
388 |
$22K |
| 99309 |
Subsequent nursing facility care, per day, low to moderate complexity |
273 |
238 |
$20K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
268 |
226 |
$10K |
| A0100 |
Non-emergency transportation; taxi |
153 |
42 |
$8K |
| S0209 |
Wheelchair van, mileage, per mile |
826 |
252 |
$8K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
344 |
284 |
$6K |
| 90837 |
Psychotherapy, 53 minutes with patient |
72 |
38 |
$6K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
165 |
133 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
64 |
61 |
$2K |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
46 |
38 |
$2K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
116 |
105 |
$1K |
| 96127 |
|
302 |
269 |
$866.05 |
| 99307 |
|
12 |
12 |
$489.18 |
| 92551 |
|
95 |
85 |
$357.36 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
102 |
90 |
$355.77 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
37 |
35 |
$318.30 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
13 |
$83.72 |
| 99173 |
|
98 |
88 |
$82.54 |
| 90686 |
|
15 |
14 |
$38.82 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
16 |
16 |
$13.06 |
| X5622 |
|
72 |
72 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
19 |
17 |
$0.00 |