| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,597 |
13,079 |
$46K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
388 |
184 |
$3K |
| 92552 |
|
389 |
389 |
$3K |
| 99386 |
|
479 |
479 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
115 |
115 |
$3K |
| 86580 |
|
1,123 |
1,113 |
$2K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
445 |
445 |
$2K |
| 85018 |
|
1,089 |
1,072 |
$1K |
| 92551 |
|
223 |
223 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
57 |
56 |
$1K |
| 99173 |
|
430 |
425 |
$928.62 |
| 99000 |
|
4,346 |
4,251 |
$845.37 |
| 81000 |
|
458 |
452 |
$825.08 |
| 99385 |
|
44 |
44 |
$796.02 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
74 |
74 |
$794.22 |
| 99401 |
|
29 |
27 |
$553.03 |
| 83655 |
|
46 |
46 |
$482.72 |
| A4268 |
Contraceptive supply, condom, female, each |
12 |
12 |
$172.80 |
| 81002 |
|
910 |
895 |
$140.36 |
| 82947 |
|
50 |
50 |
$126.23 |
| 82465 |
|
51 |
51 |
$124.49 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
31 |
31 |
$112.50 |
| 90686 |
|
12 |
12 |
$108.00 |
| 87110 |
|
824 |
822 |
$90.60 |
| 36415 |
Collection of venous blood by venipuncture |
250 |
244 |
$63.00 |
| 81007 |
|
14 |
14 |
$57.12 |
| 83026 |
|
83 |
83 |
$45.52 |
| 81025 |
|
13 |
13 |
$36.40 |
| 81003 |
|
837 |
825 |
$13.14 |
| 87590 |
|
795 |
793 |
$0.00 |
| 3008F |
|
996 |
991 |
$0.00 |
| 3075F |
|
209 |
200 |
$0.00 |
| 3079F |
|
114 |
112 |
$0.00 |
| 90674 |
|
13 |
13 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
56 |
56 |
$0.00 |
| 3074F |
|
134 |
129 |
$0.00 |
| 99172 |
|
124 |
124 |
$0.00 |
| 90649 |
|
16 |
15 |
$0.00 |
| 3078F |
|
360 |
339 |
$0.00 |
| 92081 |
|
67 |
67 |
$0.00 |
| 3015F |
|
13 |
13 |
$0.00 |