| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,706 |
2,486 |
$97K |
| 99091 |
|
445 |
443 |
$71K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
600 |
581 |
$30K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
36 |
36 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
348 |
200 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
102 |
48 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$993.17 |
| 81003 |
|
306 |
300 |
$443.48 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
28 |
27 |
$375.03 |
| 90688 |
|
13 |
13 |
$55.00 |
| 96161 |
|
15 |
15 |
$33.75 |
| 90658 |
|
58 |
58 |
$0.00 |
| 96127 |
|
50 |
50 |
$0.00 |