| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2021 |
Day habilitation, waiver; per 15 minutes |
3,191 |
415 |
$275K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
8,199 |
5,818 |
$137K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
24,308 |
11,919 |
$98K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,649 |
1,406 |
$14K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
690 |
613 |
$10K |
| 99490 |
Ccm add 20min |
877 |
768 |
$7K |
| 90834 |
Psychotherapy, 45 minutes with patient |
273 |
212 |
$6K |
| 90688 |
|
265 |
192 |
$2K |
| A0110 |
Non-emergency transportation and bus, intra or inter state carrier |
257 |
36 |
$2K |
| 90832 |
Psychotherapy, 30 minutes with patient |
131 |
123 |
$2K |
| 69210 |
|
60 |
60 |
$977.92 |
| A0425 |
Ground mileage, per statute mile |
463 |
60 |
$747.50 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
185 |
139 |
$538.24 |
| 36415 |
Collection of venous blood by venipuncture |
244 |
218 |
$426.38 |
| 86580 |
|
141 |
126 |
$332.90 |
| 93000 |
|
64 |
50 |
$290.90 |
| 81002 |
|
233 |
202 |
$273.22 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
25 |
13 |
$203.82 |
| G0008 |
Administration of influenza virus vaccine |
67 |
65 |
$12.52 |
| A0120 |
Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems |
54 |
25 |
$0.00 |