| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,305 |
5,476 |
$21K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
13 |
13 |
$1K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
16 |
16 |
$1K |
| 71046 |
Radiologic examination, chest; 2 views |
27 |
27 |
$714.48 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$597.36 |
| 90686 |
|
148 |
148 |
$584.25 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
70 |
68 |
$550.36 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
598 |
574 |
$545.00 |
| 99050 |
|
407 |
391 |
$480.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
70 |
68 |
$425.20 |
| V2020 |
Frames, purchases |
17 |
17 |
$404.89 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
17 |
17 |
$366.18 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
2,266 |
2,239 |
$363.21 |
| 86580 |
|
150 |
148 |
$289.50 |
| 90715 |
|
40 |
40 |
$280.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
424 |
415 |
$270.00 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
504 |
494 |
$172.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
63 |
63 |
$160.00 |
| 81001 |
|
1,739 |
1,677 |
$138.00 |
| 82977 |
|
462 |
461 |
$101.00 |
| 80076 |
|
462 |
461 |
$99.00 |
| 85049 |
|
2,214 |
2,188 |
$98.00 |
| 83721 |
|
916 |
916 |
$89.00 |
| 84550 |
|
415 |
414 |
$73.00 |
| 3008F |
|
425 |
425 |
$65.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
389 |
389 |
$63.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
713 |
706 |
$55.39 |
| 82962 |
|
184 |
168 |
$40.00 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
63 |
61 |
$26.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
139 |
138 |
$23.25 |
| 92552 |
|
458 |
457 |
$21.00 |
| 86703 |
|
12 |
12 |
$20.00 |
| 92081 |
|
489 |
488 |
$18.00 |
| 80053 |
Comprehensive metabolic panel |
552 |
550 |
$13.00 |
| 86592 |
|
14 |
14 |
$13.00 |
| 84439 |
|
148 |
146 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
59 |
59 |
$0.00 |
| 80061 |
Lipid panel |
930 |
930 |
$0.00 |
| 97803 |
|
209 |
209 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
28 |
28 |
$0.00 |
| 83655 |
|
467 |
467 |
$0.00 |
| 99173 |
|
321 |
320 |
$0.00 |
| 90670 |
|
16 |
16 |
$0.00 |
| 3725F |
|
283 |
282 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
61 |
61 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
40 |
40 |
$0.00 |
| 90734 |
|
15 |
15 |
$0.00 |
| G0270 |
Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes |
95 |
95 |
$0.00 |
| 82274 |
|
15 |
15 |
$0.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
199 |
199 |
$0.00 |
| 86706 |
|
60 |
60 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
17 |
17 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
343 |
341 |
$0.00 |
| 87340 |
|
152 |
152 |
$0.00 |
| 86481 |
|
15 |
15 |
$0.00 |
| 88142 |
|
82 |
82 |
$0.00 |
| 92551 |
|
233 |
232 |
$0.00 |
| 90688 |
|
80 |
80 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
40 |
40 |
$0.00 |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
20 |
20 |
$0.00 |
| 86762 |
|
12 |
12 |
$0.00 |