| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| Z0104 |
|
4,914 |
523 |
$688K |
| 99479 |
Subsequent intensive care, per day, very low birth weight infant |
1,814 |
187 |
$233K |
| Z0102 |
|
718 |
68 |
$141K |
| Z0100 |
|
320 |
302 |
$124K |
| 99480 |
Subsequent intensive care, per day, low birth weight infant |
763 |
146 |
$96K |
| 99477 |
|
217 |
206 |
$71K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
809 |
760 |
$53K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
1,017 |
531 |
$39K |
| 99222 |
Initial hospital care, per day, moderate complexity |
43 |
41 |
$9K |
| Z0106 |
|
128 |
25 |
$9K |
| 92551 |
|
689 |
689 |
$8K |
| 99468 |
|
13 |
12 |
$5K |
| 99233 |
Prolong inpt eval add15 m |
82 |
37 |
$5K |
| 99223 |
Prolong inpt eval add15 m |
30 |
30 |
$3K |
| 90686 |
|
480 |
480 |
$2K |
| 99205 |
Prolong outpt/office vis |
12 |
12 |
$2K |
| 90670 |
|
269 |
265 |
$2K |
| 90698 |
|
243 |
238 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
222 |
217 |
$1K |
| 90685 |
|
221 |
221 |
$1K |
| 90651 |
|
151 |
151 |
$1K |
| 90633 |
|
125 |
124 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
449 |
447 |
$836.62 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
44 |
42 |
$753.30 |
| 99460 |
|
13 |
13 |
$658.49 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
412 |
409 |
$646.37 |
| 90680 |
|
61 |
61 |
$549.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
60 |
58 |
$469.13 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
338 |
338 |
$464.55 |
| 90744 |
|
49 |
48 |
$440.91 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
157 |
157 |
$417.97 |
| 90734 |
|
31 |
31 |
$279.00 |
| 90710 |
|
30 |
30 |
$270.00 |
| 90707 |
|
26 |
26 |
$234.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
231 |
228 |
$222.10 |
| 90696 |
|
15 |
15 |
$135.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
43 |
42 |
$129.06 |
| 90715 |
|
14 |
14 |
$126.00 |
| 90716 |
|
14 |
14 |
$126.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
32 |
32 |
$54.01 |
| 81002 |
|
54 |
54 |
$6.61 |
| 1220F |
|
26 |
26 |
$0.00 |