| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
241 |
225 |
$16K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
23,634 |
18,274 |
$12K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
170 |
158 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
25,066 |
20,080 |
$9K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
79 |
61 |
$9K |
| 71046 |
Radiologic examination, chest; 2 views |
6,262 |
5,598 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
113 |
113 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
64 |
64 |
$7K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
21,229 |
16,933 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
5,357 |
4,892 |
$3K |
| D1206 |
Topical application of fluoride varnish |
134 |
134 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
447 |
440 |
$3K |
| G0380 |
Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
13 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
52 |
12 |
$2K |
| 72040 |
|
4,924 |
4,462 |
$962.10 |
| D0191 |
|
64 |
64 |
$830.45 |
| 90834 |
Psychotherapy, 45 minutes with patient |
2,032 |
1,426 |
$664.02 |
| 0124A |
|
83 |
82 |
$144.00 |
| D0120 |
Periodic oral evaluation - established patient |
8,332 |
6,986 |
$140.25 |
| 0004A |
|
41 |
41 |
$72.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
337 |
319 |
$24.26 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,390 |
2,116 |
$0.00 |
| 0071A |
|
83 |
83 |
$0.00 |
| D0190 |
|
14 |
14 |
$0.00 |
| D1330 |
|
121 |
82 |
$0.00 |
| 90686 |
|
181 |
180 |
$0.00 |
| 90656 |
|
13 |
13 |
$0.00 |
| 0072A |
|
85 |
85 |
$0.00 |
| 71020 |
|
16 |
14 |
$0.00 |