| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
398 |
398 |
$48K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
342 |
338 |
$30K |
| T1015 |
Clinic visit/encounter, all-inclusive |
64 |
63 |
$10K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
169 |
169 |
$7K |
| 87428 |
|
129 |
129 |
$6K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
179 |
179 |
$5K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
88 |
84 |
$4K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
337 |
169 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
34 |
34 |
$3K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
12 |
12 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19 |
19 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
14 |
13 |
$1K |
| 90715 |
|
21 |
21 |
$672.80 |
| 99051 |
|
543 |
532 |
$612.72 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
42 |
41 |
$380.10 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
18 |
18 |
$368.10 |
| 90686 |
|
12 |
12 |
$228.36 |
| S9088 |
Services provided in an urgent care center (list in addition to code for service) |
320 |
315 |
$0.00 |