| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
19,720 |
13,853 |
$1.35M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27,582 |
18,436 |
$1.23M |
| 99199 |
Unlisted special service, procedure or report |
48,063 |
27,885 |
$277K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
2,021 |
1,592 |
$193K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,560 |
1,951 |
$176K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,272 |
976 |
$91K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,819 |
2,240 |
$89K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,781 |
3,662 |
$73K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
829 |
620 |
$68K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
1,151 |
785 |
$65K |
| 76801 |
|
873 |
663 |
$63K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
982 |
761 |
$62K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
969 |
688 |
$58K |
| 81025 |
|
6,664 |
4,732 |
$37K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
461 |
255 |
$35K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
1,018 |
814 |
$33K |
| 59430 |
|
324 |
213 |
$26K |
| 96127 |
|
6,892 |
5,149 |
$25K |
| 76819 |
Fetal biophysical profile; without non-stress testing |
497 |
206 |
$23K |
| 96161 |
|
7,126 |
5,316 |
$22K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
308 |
236 |
$21K |
| 99051 |
|
1,087 |
823 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
625 |
474 |
$18K |
| 96160 |
|
5,958 |
4,438 |
$18K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
164 |
127 |
$14K |
| 99381 |
|
165 |
132 |
$12K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,918 |
1,417 |
$12K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
231 |
112 |
$12K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
973 |
693 |
$11K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
161 |
128 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
315 |
218 |
$9K |
| D1206 |
Topical application of fluoride varnish |
622 |
474 |
$8K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
461 |
347 |
$7K |
| 81003 |
|
3,490 |
2,508 |
$7K |
| 99383 |
|
63 |
43 |
$4K |
| 99384 |
|
49 |
32 |
$4K |
| 90715 |
|
113 |
83 |
$3K |
| 76813 |
|
43 |
31 |
$3K |
| 99385 |
|
61 |
40 |
$2K |
| 92551 |
|
1,204 |
940 |
$2K |
| 76830 |
Ultrasound, transvaginal |
25 |
25 |
$2K |
| 58300 |
|
30 |
26 |
$2K |
| 59025 |
Fetal non-stress test |
92 |
34 |
$2K |
| 99382 |
|
26 |
17 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
107 |
104 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
100 |
95 |
$1K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
17 |
12 |
$1K |
| 87210 |
|
317 |
244 |
$1K |
| 11981 |
|
19 |
12 |
$935.71 |
| 99173 |
|
1,491 |
1,126 |
$363.37 |
| 90686 |
|
574 |
473 |
$251.26 |
| 85018 |
|
216 |
156 |
$214.07 |
| 88720 |
|
72 |
27 |
$37.38 |
| 90670 |
|
1,369 |
1,119 |
$0.00 |
| 90633 |
|
379 |
305 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
506 |
387 |
$0.00 |
| 90710 |
|
48 |
39 |
$0.00 |
| 90734 |
|
48 |
40 |
$0.00 |
| 90700 |
|
29 |
29 |
$0.00 |
| 90680 |
|
716 |
580 |
$0.00 |
| 90744 |
|
393 |
352 |
$0.00 |
| 90651 |
|
110 |
86 |
$0.00 |
| 90698 |
|
679 |
586 |
$0.00 |
| 90697 |
|
99 |
76 |
$0.00 |
| 90723 |
|
41 |
26 |
$0.00 |
| 90647 |
|
48 |
30 |
$0.00 |
| 81000 |
|
23 |
15 |
$0.00 |