| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
728 |
714 |
$53K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,970 |
4,587 |
$53K |
| 59514 |
|
217 |
217 |
$44K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,798 |
5,250 |
$39K |
| 59425 |
|
437 |
293 |
$38K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
325 |
324 |
$22K |
| H1003 |
Prenatal care, at-risk enhanced service; education |
769 |
613 |
$22K |
| 90686 |
|
1,132 |
1,119 |
$20K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
212 |
212 |
$18K |
| Z1034 |
|
305 |
204 |
$16K |
| 90670 |
|
510 |
502 |
$8K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
12 |
12 |
$8K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,395 |
1,309 |
$7K |
| 90648 |
|
406 |
398 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
63 |
63 |
$7K |
| 90723 |
|
215 |
215 |
$4K |
| Z6410 |
|
135 |
107 |
$4K |
| 90707 |
|
117 |
112 |
$2K |
| 97803 |
|
88 |
88 |
$2K |
| 90685 |
|
109 |
109 |
$2K |
| 90716 |
|
86 |
86 |
$2K |
| 90682 |
|
50 |
50 |
$2K |
| 99381 |
|
12 |
12 |
$1K |
| Z6400 |
|
60 |
54 |
$1K |
| 92552 |
|
40 |
40 |
$1K |
| 90681 |
|
56 |
56 |
$999.00 |
| 90688 |
|
43 |
43 |
$808.32 |
| 85018 |
|
341 |
340 |
$788.61 |
| 99215 |
Prolong outpt/office vis |
15 |
15 |
$749.45 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
76 |
38 |
$654.03 |
| Z6204 |
|
25 |
25 |
$620.74 |
| 90633 |
|
27 |
24 |
$486.00 |
| 81003 |
|
117 |
109 |
$256.67 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
17 |
14 |
$252.56 |
| 90651 |
|
14 |
14 |
$252.00 |
| 90734 |
|
12 |
12 |
$216.00 |
| 86580 |
|
33 |
32 |
$173.19 |
| 81025 |
|
40 |
39 |
$162.22 |
| 99401 |
|
12 |
12 |
$100.92 |
| 90662 |
|
83 |
83 |
$85.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
44 |
44 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
169 |
169 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
12 |
12 |
$0.00 |