| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0001A |
|
668 |
666 |
$20K |
| 0002A |
|
551 |
551 |
$17K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
271 |
264 |
$13K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
635 |
630 |
$7K |
| 0003A |
|
161 |
161 |
$6K |
| 0012A |
|
62 |
62 |
$2K |
| 90619 |
|
13 |
13 |
$2K |
| 90686 |
|
134 |
134 |
$2K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
61 |
25 |
$2K |
| 91320 |
|
13 |
13 |
$2K |
| 99254 |
|
12 |
12 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
56 |
51 |
$1K |
| 0013A |
|
29 |
29 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
38 |
37 |
$979.95 |
| 90715 |
|
39 |
39 |
$974.33 |
| 0011A |
|
41 |
41 |
$881.64 |
| 90674 |
|
53 |
53 |
$625.56 |
| 0071A |
|
14 |
14 |
$520.00 |
| 0072A |
|
12 |
12 |
$480.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
27 |
27 |
$473.00 |
| 90688 |
|
12 |
12 |
$198.36 |