| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,445 |
5,363 |
$269K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,525 |
5,554 |
$190K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,375 |
1,277 |
$93K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,439 |
1,187 |
$81K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
926 |
858 |
$65K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,826 |
2,469 |
$47K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
3,168 |
2,769 |
$33K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
330 |
308 |
$26K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,878 |
1,736 |
$13K |
| 90461 |
|
1,747 |
1,340 |
$10K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
544 |
456 |
$10K |
| 99381 |
|
37 |
32 |
$2K |
| 99050 |
|
29 |
27 |
$288.96 |
| 87807 |
|
30 |
25 |
$231.00 |
| 81002 |
|
39 |
37 |
$108.46 |
| S3620 |
Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-d; phenylalanine (pku); and thyroxine, total) |
16 |
13 |
$80.00 |
| 90686 |
|
703 |
654 |
$0.26 |
| 90723 |
|
412 |
370 |
$0.00 |
| 90716 |
|
14 |
14 |
$0.00 |
| 36416 |
|
20 |
13 |
$0.00 |
| 96127 |
|
46 |
41 |
$0.00 |
| 90696 |
|
27 |
27 |
$0.00 |
| 90651 |
|
19 |
19 |
$0.00 |
| 90677 |
|
15 |
14 |
$0.00 |
| 90633 |
|
234 |
225 |
$0.00 |
| 90648 |
|
760 |
669 |
$0.00 |
| 90670 |
|
667 |
588 |
$0.00 |
| 90710 |
|
30 |
30 |
$0.00 |
| 90734 |
|
63 |
54 |
$0.00 |
| 90681 |
|
65 |
58 |
$0.00 |
| 90715 |
|
15 |
15 |
$0.00 |