| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 3078F |
|
219 |
187 |
$2K |
| 99499 |
|
219 |
158 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
196 |
169 |
$2K |
| 1160F |
|
211 |
196 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
116 |
115 |
$1K |
| 1158F |
|
217 |
205 |
$750.00 |
| 1170F |
|
129 |
128 |
$750.00 |
| 3079F |
|
90 |
85 |
$650.00 |
| 3008F |
|
147 |
133 |
$575.00 |
| 1159F |
|
209 |
195 |
$475.00 |
| 3725F |
|
131 |
130 |
$425.00 |
| G0396 |
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes |
55 |
52 |
$150.00 |
| 3074F |
|
223 |
192 |
$75.00 |
| 3075F |
|
88 |
80 |
$25.00 |
| 1157F |
|
200 |
188 |
$25.00 |
| G0438 |
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
47 |
47 |
$0.00 |
| 93000 |
|
15 |
15 |
$0.00 |