| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
10,442 |
8,823 |
$502K |
| 90651 |
|
73 |
73 |
$839.16 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
557 |
554 |
$336.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,039 |
1,031 |
$294.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
750 |
726 |
$226.46 |
| 71046 |
Radiologic examination, chest; 2 views |
29 |
25 |
$98.10 |
| 36415 |
Collection of venous blood by venipuncture |
507 |
487 |
$67.50 |
| 90715 |
|
26 |
26 |
$32.27 |
| 81002 |
|
456 |
433 |
$30.32 |
| 81025 |
|
13 |
13 |
$7.13 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
282 |
280 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
313 |
307 |
$0.00 |
| 90670 |
|
205 |
205 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
289 |
145 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
24 |
24 |
$0.00 |
| 90633 |
|
154 |
153 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
364 |
362 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
39 |
39 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
326 |
326 |
$0.00 |
| 90685 |
|
44 |
44 |
$0.00 |
| 99051 |
|
900 |
868 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
219 |
218 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
26 |
26 |
$0.00 |
| 90621 |
|
15 |
14 |
$0.00 |
| 90734 |
|
32 |
32 |
$0.00 |
| 90682 |
|
15 |
15 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,340 |
2,132 |
$0.00 |
| 94760 |
|
316 |
293 |
$0.00 |
| 90698 |
|
121 |
121 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,867 |
5,183 |
$0.00 |
| 90744 |
|
28 |
28 |
$0.00 |
| 90686 |
|
254 |
251 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
24 |
24 |
$0.00 |
| 90680 |
|
25 |
25 |
$0.00 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
14 |
14 |
$0.00 |