| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
41,839 |
24,415 |
$246K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,856 |
2,273 |
$153K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
256 |
179 |
$21K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
835 |
627 |
$12K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
141 |
93 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
56 |
45 |
$5K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
107 |
83 |
$5K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
64 |
50 |
$3K |
| 87428 |
|
41 |
27 |
$2K |
| 96160 |
|
821 |
555 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
18 |
12 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
165 |
128 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
445 |
196 |
$654.40 |
| 92553 |
|
33 |
24 |
$583.06 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
65 |
52 |
$565.22 |
| 99401 |
|
18 |
13 |
$494.12 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$456.12 |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
203 |
185 |
$423.32 |
| 90686 |
|
276 |
187 |
$348.63 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$201.36 |
| 92551 |
|
79 |
67 |
$200.50 |
| 87276 |
|
14 |
14 |
$197.82 |
| 87275 |
|
14 |
14 |
$197.82 |
| 90461 |
|
167 |
73 |
$160.92 |
| 99173 |
|
79 |
63 |
$101.24 |
| 81003 |
|
16 |
13 |
$36.01 |
| 99177 |
|
20 |
15 |
$10.44 |
| 36416 |
|
27 |
25 |
$0.00 |
| 90670 |
|
18 |
12 |
$0.00 |