| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
42 |
33 |
$873.64 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16 |
16 |
$861.22 |
| 84443 |
Thyroid stimulating hormone (TSH) |
25 |
25 |
$303.16 |
| 80053 |
Comprehensive metabolic panel |
25 |
25 |
$195.95 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
14 |
14 |
$87.49 |
| 81002 |
|
18 |
16 |
$48.78 |
| 36415 |
Collection of venous blood by venipuncture |
12 |
12 |
$25.56 |
| 99000 |
|
35 |
29 |
$0.00 |