| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,247 |
787 |
$66K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
923 |
699 |
$27K |
| 99199 |
Unlisted special service, procedure or report |
4,115 |
2,345 |
$24K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
93 |
55 |
$7K |
| 81025 |
|
532 |
354 |
$3K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
65 |
56 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
12 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
13 |
$1K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
17 |
13 |
$1K |
| 96127 |
|
40 |
24 |
$117.90 |
| 85018 |
|
64 |
39 |
$117.30 |
| 81003 |
|
38 |
28 |
$36.32 |