| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90461 |
|
555 |
549 |
$10K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,886 |
1,711 |
$8K |
| 92551 |
|
569 |
568 |
$5K |
| 92588 |
|
104 |
103 |
$1K |
| 86580 |
|
112 |
112 |
$856.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,915 |
2,486 |
$202.50 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
438 |
379 |
$162.84 |
| 90656 |
|
34 |
34 |
$138.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
443 |
431 |
$74.04 |
| 90677 |
|
13 |
13 |
$54.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
15 |
14 |
$34.34 |
| 90688 |
|
164 |
163 |
$5.94 |
| G9920 |
Screening performed and negative |
335 |
327 |
$0.00 |
| 90685 |
|
14 |
12 |
$0.00 |
| 83655 |
|
57 |
56 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
418 |
375 |
$0.00 |
| 97803 |
|
13 |
13 |
$0.00 |
| 81003 |
|
76 |
74 |
$0.00 |
| 90621 |
|
13 |
13 |
$0.00 |
| 90707 |
|
12 |
12 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
144 |
142 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
168 |
128 |
$0.00 |
| 3351F |
|
27 |
26 |
$0.00 |
| 99174 |
|
82 |
81 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
181 |
177 |
$0.00 |
| 82728 |
|
107 |
106 |
$0.00 |
| 97802 |
|
166 |
163 |
$0.00 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
118 |
113 |
$0.00 |
| 90651 |
|
35 |
35 |
$0.00 |
| 90674 |
|
15 |
15 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$0.00 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
12 |
12 |
$0.00 |