| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,769 |
4,397 |
$173K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
580 |
501 |
$76K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,015 |
769 |
$43K |
| S0209 |
Wheelchair van, mileage, per mile |
2,313 |
265 |
$40K |
| 36415 |
Collection of venous blood by venipuncture |
2,539 |
1,948 |
$21K |
| S0215 |
Non-emergency transportation; mileage, per mile |
204 |
65 |
$12K |
| A0130 |
Non-emergency transportation: wheelchair van |
1,667 |
261 |
$12K |
| 90837 |
Psychotherapy, 53 minutes with patient |
415 |
213 |
$11K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
466 |
397 |
$10K |
| 96127 |
|
198 |
189 |
$10K |
| A0425 |
Ground mileage, per statute mile |
28 |
18 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
248 |
200 |
$5K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
18 |
14 |
$5K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
166 |
146 |
$5K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
105 |
99 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
175 |
165 |
$3K |
| 80053 |
Comprehensive metabolic panel |
101 |
88 |
$3K |
| T2003 |
Non-emergency transportation; encounter/trip |
181 |
65 |
$2K |
| Q2038 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
12 |
12 |
$1K |
| 90686 |
|
169 |
159 |
$861.56 |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
17 |
15 |
$828.74 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
21 |
13 |
$702.94 |
| 84443 |
Thyroid stimulating hormone (TSH) |
55 |
51 |
$568.78 |
| 92551 |
|
65 |
62 |
$448.37 |
| G0008 |
Administration of influenza virus vaccine |
41 |
41 |
$447.67 |
| 85018 |
|
37 |
37 |
$447.60 |
| 81001 |
|
28 |
24 |
$417.04 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$152.20 |
| 80061 |
Lipid panel |
14 |
13 |
$136.93 |
| 99173 |
|
83 |
74 |
$113.00 |
| P9604 |
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge |
110 |
65 |
$24.55 |