| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
772 |
694 |
$48K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
361 |
349 |
$34K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
362 |
357 |
$20K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
80 |
78 |
$8K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
74 |
71 |
$7K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
161 |
161 |
$6K |
| 99460 |
|
70 |
66 |
$6K |
| 54150 |
|
45 |
41 |
$4K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
91 |
84 |
$1K |
| A4550 |
Surgical trays |
97 |
89 |
$852.90 |
| 94760 |
|
246 |
236 |
$594.93 |
| 64450 |
|
89 |
82 |
$368.00 |
| 85018 |
|
83 |
82 |
$200.83 |
| 81002 |
|
68 |
65 |
$132.99 |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
89 |
82 |
$13.00 |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
68 |
65 |
$2.08 |
| 90670 |
|
118 |
116 |
$0.00 |
| 90744 |
|
29 |
28 |
$0.00 |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
97 |
89 |
$0.00 |
| 99000 |
|
88 |
72 |
$0.00 |
| 90698 |
|
61 |
60 |
$0.00 |
| 90680 |
|
61 |
60 |
$0.00 |