| Code | Description | Claims | Beneficiaries | Total Paid |
| S0209 |
Wheelchair van, mileage, per mile |
2,272 |
785 |
$141K |
| S0215 |
Non-emergency transportation; mileage, per mile |
1,918 |
582 |
$109K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,890 |
1,484 |
$69K |
| A0130 |
Non-emergency transportation: wheelchair van |
2,242 |
814 |
$57K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
549 |
473 |
$41K |
| 99309 |
Subsequent nursing facility care, per day, low to moderate complexity |
464 |
416 |
$31K |
| T2003 |
Non-emergency transportation; encounter/trip |
1,878 |
601 |
$26K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
149 |
137 |
$15K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
207 |
194 |
$14K |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
92 |
90 |
$6K |
| 90837 |
Psychotherapy, 53 minutes with patient |
49 |
29 |
$4K |
| 99307 |
|
57 |
56 |
$2K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
38 |
38 |
$2K |
| 86580 |
|
164 |
154 |
$1K |
| 99310 |
Prolong nursin fac eval 15m |
13 |
13 |
$1K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
27 |
25 |
$1K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
61 |
58 |
$1K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
33 |
31 |
$995.70 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
35 |
31 |
$740.66 |
| 92551 |
|
36 |
36 |
$259.21 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
12 |
12 |
$254.16 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
29 |
29 |
$190.08 |
| 96127 |
|
40 |
37 |
$133.76 |
| 99173 |
|
38 |
38 |
$56.49 |
| 99188 |
|
29 |
27 |
$52.66 |