| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90750 |
|
258 |
258 |
$42K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
24,186 |
23,491 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
21,189 |
20,713 |
$12K |
| 92551 |
|
728 |
727 |
$8K |
| 90715 |
|
201 |
201 |
$7K |
| 90686 |
|
856 |
852 |
$6K |
| 90688 |
|
516 |
516 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
533 |
521 |
$5K |
| 90837 |
Psychotherapy, 53 minutes with patient |
92 |
55 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,437 |
4,284 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
330 |
320 |
$3K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
129 |
123 |
$2K |
| 87536 |
|
48 |
44 |
$1K |
| 90656 |
|
75 |
75 |
$1K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
89 |
89 |
$1K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
831 |
776 |
$1K |
| 86360 |
|
46 |
44 |
$776.16 |
| 86592 |
|
104 |
101 |
$574.62 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
213 |
212 |
$570.70 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
88 |
86 |
$411.48 |
| 90734 |
|
27 |
27 |
$187.11 |
| 82465 |
|
22 |
21 |
$149.14 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,836 |
1,835 |
$135.20 |
| 90710 |
|
17 |
17 |
$108.00 |
| 99234 |
|
67 |
57 |
$102.30 |
| 81003 |
|
84 |
83 |
$96.84 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
80 |
80 |
$86.82 |
| 90672 |
|
13 |
13 |
$80.19 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
56 |
56 |
$74.04 |
| 90651 |
|
13 |
13 |
$71.28 |
| 90633 |
|
14 |
14 |
$71.28 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
114 |
114 |
$68.21 |
| 90670 |
|
13 |
13 |
$44.55 |
| 99000 |
|
28 |
28 |
$39.49 |
| 86703 |
|
181 |
181 |
$35.52 |
| A4267 |
Contraceptive supply, condom, male, each |
68 |
66 |
$22.94 |
| 80305 |
|
57 |
50 |
$9.88 |
| 85018 |
|
26 |
26 |
$6.15 |
| 82962 |
|
14 |
13 |
$3.96 |
| 81025 |
|
27 |
27 |
$2.77 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
113 |
110 |
$0.00 |
| 99188 |
|
46 |
38 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
323 |
323 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
17 |
16 |
$0.00 |
| G9920 |
Screening performed and negative |
71 |
71 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
24 |
24 |
$0.00 |