| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,198 |
1,836 |
$138K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
634 |
616 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
137 |
127 |
$11K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
93 |
93 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
77 |
74 |
$5K |
| 97803 |
|
263 |
260 |
$4K |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
201 |
200 |
$3K |
| 92551 |
|
250 |
248 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
28 |
28 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
178 |
178 |
$2K |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
29 |
29 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
89 |
86 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
16 |
16 |
$1K |
| 90461 |
|
31 |
31 |
$978.56 |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
151 |
151 |
$848.97 |
| 99051 |
|
103 |
98 |
$504.27 |
| 99173 |
|
222 |
219 |
$486.23 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
24 |
23 |
$426.00 |
| 92558 |
|
56 |
56 |
$418.17 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
30 |
30 |
$398.49 |
| 36415 |
Collection of venous blood by venipuncture |
220 |
213 |
$371.31 |
| 81002 |
|
143 |
143 |
$346.69 |
| 39402 |
|
15 |
15 |
$300.00 |
| A4927 |
Gloves, non-sterile, per 100 |
265 |
263 |
$296.10 |
| 99000 |
|
48 |
47 |
$220.90 |
| 90648 |
|
14 |
14 |
$125.00 |
| 90700 |
|
14 |
14 |
$125.00 |
| 96161 |
|
144 |
143 |
$115.71 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
718 |
696 |
$52.69 |
| 90686 |
|
34 |
34 |
$20.53 |
| A4245 |
Alcohol wipes, per box |
92 |
89 |
$3.60 |
| A6413 |
Adhesive bandage, first-aid type, any size, each |
12 |
12 |
$0.00 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
86 |
86 |
$0.00 |
| 3008F |
|
111 |
111 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
13 |
13 |
$0.00 |