| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,127 |
975 |
$89K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
56 |
52 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
41 |
40 |
$5K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
1,216 |
1,216 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
193 |
185 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$2K |
| 90686 |
|
54 |
54 |
$800.84 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
14 |
14 |
$472.76 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
26 |
25 |
$472.36 |
| 87400 |
|
17 |
17 |
$266.11 |
| 99173 |
|
15 |
15 |
$58.75 |