| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
603 |
553 |
$21K |
| 99244 |
Office or other outpatient consultation, moderate to high complexity |
229 |
226 |
$12K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
73 |
71 |
$5K |
| A4580 |
Cast supplies (e.g., plaster) |
111 |
84 |
$1K |
| A4590 |
Special casting material (e.g., fiberglass) |
134 |
109 |
$469.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
12 |
$277.46 |
| 73100 |
|
82 |
64 |
$73.22 |
| 73610 |
|
13 |
12 |
$0.00 |
| 73140 |
|
35 |
27 |
$0.00 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$0.00 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
12 |
12 |
$0.00 |