| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,995 |
1,604 |
$139K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,604 |
2,756 |
$119K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,354 |
1,997 |
$111K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
8,329 |
6,882 |
$100K |
| 90837 |
Psychotherapy, 53 minutes with patient |
369 |
213 |
$42K |
| S5130 |
Homemaker service, nos; per 15 minutes |
936 |
81 |
$38K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
336 |
284 |
$21K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,138 |
1,083 |
$18K |
| 99401 |
|
622 |
393 |
$15K |
| 96127 |
|
968 |
924 |
$14K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
416 |
334 |
$11K |
| 99383 |
|
136 |
131 |
$11K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
162 |
150 |
$10K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
370 |
292 |
$10K |
| 90734 |
|
356 |
294 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
98 |
90 |
$7K |
| 90686 |
|
466 |
423 |
$6K |
| 81025 |
|
1,645 |
1,132 |
$6K |
| S4993 |
Contraceptive pills for birth control |
183 |
135 |
$6K |
| 99384 |
|
65 |
65 |
$5K |
| 36416 |
|
944 |
847 |
$3K |
| 90619 |
|
192 |
181 |
$3K |
| 90715 |
|
231 |
204 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
59 |
54 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
83 |
81 |
$2K |
| 90710 |
|
88 |
81 |
$2K |
| H1000 |
Prenatal care, at-risk assessment |
146 |
141 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
135 |
114 |
$2K |
| 90651 |
|
96 |
95 |
$1K |
| 90756 |
|
56 |
53 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
57 |
30 |
$907.70 |
| 90670 |
|
90 |
86 |
$579.20 |
| 90696 |
|
54 |
52 |
$462.00 |
| 99382 |
|
13 |
12 |
$424.55 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$412.03 |
| 81002 |
|
148 |
110 |
$361.40 |
| Q3014 |
Telehealth originating site facility fee |
123 |
112 |
$0.00 |