| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
173,060 |
169,888 |
$891K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,064 |
597 |
$8K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
493 |
292 |
$7K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
368 |
216 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
43 |
36 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
12 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
1,157 |
632 |
$1K |
| 81025 |
|
380 |
161 |
$1K |
| 81003 |
|
760 |
374 |
$1K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
86 |
40 |
$785.12 |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
25 |
12 |
$500.00 |
| 85018 |
|
223 |
151 |
$418.66 |
| 87210 |
|
129 |
80 |
$357.85 |
| 87220 |
|
127 |
80 |
$334.92 |
| 90686 |
|
125 |
97 |
$322.25 |
| 82120 |
|
129 |
80 |
$275.39 |
| 90715 |
|
170 |
116 |
$156.90 |
| 83986 |
|
68 |
53 |
$141.05 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
600 |
436 |
$93.54 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
663 |
466 |
$62.36 |
| 96127 |
|
16 |
12 |
$51.55 |
| 86592 |
|
750 |
471 |
$5.42 |
| 90651 |
|
107 |
65 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
765 |
485 |
$0.00 |
| 36416 |
|
35 |
30 |
$0.00 |
| 90620 |
|
18 |
14 |
$0.00 |
| 86850 |
|
24 |
12 |
$0.00 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
26 |
12 |
$0.00 |
| 90734 |
|
442 |
250 |
$0.00 |
| 92552 |
|
15 |
13 |
$0.00 |
| 99173 |
|
15 |
13 |
$0.00 |
| 83020 |
|
17 |
13 |
$0.00 |