| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
74 |
71 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
24 |
24 |
$2K |
| G9016 |
Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only] |
122 |
89 |
$2K |
| A0425 |
Ground mileage, per statute mile |
49 |
39 |
$139.13 |