| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92552 |
|
323 |
323 |
$0.00 |
| 80061 |
Lipid panel |
1,336 |
1,329 |
$0.00 |
| 81002 |
|
34 |
34 |
$0.00 |
| 3078F |
|
108 |
103 |
$0.00 |
| T4541 |
Incontinence product, disposable underpad, large, each |
82 |
82 |
$0.00 |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
558 |
557 |
$0.00 |
| 81003 |
|
400 |
396 |
$0.00 |
| 0272 |
|
15 |
14 |
$0.00 |
| 85610 |
|
30 |
27 |
$0.00 |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
389 |
332 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
80 |
76 |
$0.00 |
| 84550 |
|
109 |
109 |
$0.00 |
| 1159F |
|
206 |
200 |
$0.00 |
| 71046 |
Radiologic examination, chest; 2 views |
272 |
268 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
119 |
119 |
$0.00 |
| 69210 |
|
196 |
196 |
$0.00 |
| 82274 |
|
248 |
248 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
85 |
85 |
$0.00 |
| 3725F |
|
124 |
123 |
$0.00 |
| 84439 |
|
115 |
115 |
$0.00 |
| 1160F |
|
172 |
166 |
$0.00 |
| 3015F |
|
58 |
54 |
$0.00 |
| 86480 |
|
162 |
162 |
$0.00 |
| 82570 |
|
261 |
260 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
92 |
92 |
$0.00 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
98 |
97 |
$0.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
83 |
82 |
$0.00 |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
152 |
148 |
$0.00 |
| 99173 |
|
702 |
702 |
$0.00 |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
37 |
37 |
$0.00 |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
121 |
60 |
$0.00 |
| 99152 |
|
27 |
27 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
43 |
43 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
12 |
12 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
318 |
318 |
$0.00 |
| 90685 |
|
13 |
13 |
$0.00 |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
62 |
62 |
$0.00 |
| 90756 |
|
48 |
48 |
$0.00 |
| 80076 |
|
14 |
14 |
$0.00 |
| 92020 |
|
12 |
12 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15 |
15 |
$0.00 |
| 3016F |
|
15 |
15 |
$0.00 |
| 76514 |
|
12 |
12 |
$0.00 |
| 86708 |
|
46 |
46 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
18 |
16 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
99 |
90 |
$0.00 |
| 88142 |
|
180 |
179 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
857 |
813 |
$0.00 |
| 81000 |
|
51 |
51 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,223 |
3,746 |
$0.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,048 |
1,040 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
1,833 |
1,734 |
$0.00 |
| 87340 |
|
208 |
208 |
$0.00 |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
389 |
386 |
$0.00 |
| 3014F |
|
56 |
53 |
$0.00 |
| 0258 |
|
109 |
106 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
797 |
789 |
$0.00 |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
185 |
184 |
$0.00 |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
232 |
232 |
$0.00 |
| 3074F |
|
104 |
98 |
$0.00 |
| 3008F |
|
183 |
178 |
$0.00 |
| 97014 |
|
123 |
60 |
$0.00 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
66 |
66 |
$0.00 |
| 86706 |
|
196 |
196 |
$0.00 |
| 3017F |
|
81 |
81 |
$0.00 |
| 0250 |
|
186 |
151 |
$0.00 |
| 86803 |
|
98 |
98 |
$0.00 |
| 80053 |
Comprehensive metabolic panel |
1,180 |
1,138 |
$0.00 |
| 87517 |
|
122 |
122 |
$0.00 |
| 92250 |
|
66 |
66 |
$0.00 |
| 92551 |
|
314 |
314 |
$0.00 |
| 85027 |
|
123 |
122 |
$0.00 |
| 80050 |
General health panel |
361 |
360 |
$0.00 |
| 97035 |
|
100 |
47 |
$0.00 |
| 81001 |
|
316 |
310 |
$0.00 |
| 1101F |
|
14 |
14 |
$0.00 |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
58 |
27 |
$0.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
269 |
269 |
$0.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
727 |
681 |
$0.00 |
| 76830 |
Ultrasound, transvaginal |
44 |
44 |
$0.00 |
| 82270 |
|
115 |
115 |
$0.00 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12 |
12 |
$0.00 |
| 82043 |
|
259 |
258 |
$0.00 |
| 1170F |
|
129 |
124 |
$0.00 |
| 1126F |
|
14 |
12 |
$0.00 |
| 1036F |
|
53 |
49 |
$0.00 |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
465 |
284 |
$0.00 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
98 |
91 |
$0.00 |
| 82105 |
|
91 |
91 |
$0.00 |
| 90686 |
|
550 |
550 |
$0.00 |
| 86704 |
|
41 |
41 |
$0.00 |
| 84153 |
|
74 |
74 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
12 |
12 |
$0.00 |
| 83921 |
|
27 |
27 |
$0.00 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
16 |
16 |
$0.00 |
| 83090 |
|
34 |
34 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
14 |
14 |
$0.00 |