| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G9002 |
Coordinated care fee, maintenance rate |
3,675 |
3,198 |
$376K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,859 |
3,614 |
$56K |
| 90686 |
|
1,550 |
1,493 |
$18K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
163 |
153 |
$12K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
819 |
777 |
$8K |
| S0215 |
Non-emergency transportation; mileage, per mile |
717 |
630 |
$5K |
| 81025 |
|
549 |
505 |
$3K |
| 90734 |
|
135 |
133 |
$3K |
| 90715 |
|
150 |
146 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
59 |
57 |
$1K |
| 90619 |
|
84 |
84 |
$1K |
| 90656 |
|
101 |
101 |
$1K |
| 90651 |
|
28 |
26 |
$821.24 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15 |
14 |
$710.04 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
76 |
74 |
$502.13 |
| 90632 |
|
12 |
12 |
$484.20 |
| 90710 |
|
12 |
12 |
$142.24 |
| 90633 |
|
12 |
12 |
$123.20 |
| 99000 |
|
37 |
37 |
$43.03 |