| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,650 |
9,053 |
$473K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,083 |
1,963 |
$221K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,842 |
1,760 |
$188K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,800 |
1,713 |
$176K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,096 |
1,034 |
$110K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,927 |
3,662 |
$45K |
| 92552 |
|
4,989 |
4,629 |
$43K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
464 |
428 |
$29K |
| 90670 |
|
667 |
625 |
$15K |
| 90461 |
|
2,008 |
1,840 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
277 |
254 |
$8K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
98 |
65 |
$7K |
| 90651 |
|
110 |
104 |
$3K |
| 90686 |
|
527 |
488 |
$863.48 |
| 99177 |
|
3,208 |
2,928 |
$689.97 |
| A4930 |
Gloves, sterile, per pair |
107 |
98 |
$605.26 |
| A4927 |
Gloves, non-sterile, per 100 |
167 |
154 |
$589.72 |
| 0071A |
|
38 |
23 |
$520.00 |
| 0072A |
|
22 |
12 |
$360.00 |
| 90633 |
|
202 |
179 |
$300.05 |
| A4928 |
Surgical mask, per 20 |
270 |
248 |
$239.75 |
| 99072 |
|
96 |
89 |
$222.24 |
| 90698 |
|
112 |
108 |
$195.88 |
| 90700 |
|
80 |
72 |
$110.00 |
| 90715 |
|
82 |
79 |
$108.87 |
| 90680 |
|
139 |
134 |
$75.00 |
| 90707 |
|
86 |
79 |
$40.00 |
| 90716 |
|
85 |
79 |
$40.00 |
| 90671 |
|
66 |
65 |
$10.00 |
| 90688 |
|
19 |
17 |
$10.00 |
| 90734 |
|
59 |
56 |
$0.00 |
| 83655 |
|
17 |
15 |
$0.00 |
| 90713 |
|
13 |
13 |
$0.00 |
| 85018 |
|
33 |
31 |
$0.00 |
| 36416 |
|
29 |
28 |
$0.00 |
| 90677 |
|
16 |
15 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
15 |
15 |
$0.00 |
| 91307 |
|
28 |
18 |
$0.00 |