| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
1,171 |
580 |
$141K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,879 |
3,587 |
$136K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,418 |
1,389 |
$82K |
| 11750 |
|
441 |
304 |
$44K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
456 |
222 |
$41K |
| 73630 |
|
1,587 |
1,028 |
$41K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
68 |
59 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
27 |
25 |
$2K |
| 11721 |
|
12 |
12 |
$315.10 |
| 99072 |
|
20 |
20 |
$90.00 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
114 |
99 |
$2.41 |
| 1111F |
|
330 |
304 |
$0.00 |
| 99002 |
|
103 |
102 |
$0.00 |
| 1036F |
|
228 |
205 |
$0.00 |
| S5000 |
Prescription drug, generic |
237 |
227 |
$0.00 |
| A4550 |
Surgical trays |
182 |
173 |
$0.00 |