| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
383 |
366 |
$16K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
170 |
161 |
$11K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
190 |
158 |
$4K |
| 90670 |
|
12 |
12 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
36 |
33 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
94 |
89 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
20 |
20 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
107 |
105 |
$861.55 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$701.34 |
| 99051 |
|
35 |
18 |
$680.00 |
| 92587 |
|
15 |
15 |
$263.51 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
20 |
20 |
$243.59 |
| 99177 |
|
14 |
14 |
$152.53 |
| 36416 |
|
17 |
17 |
$60.75 |
| 85018 |
|
17 |
17 |
$29.84 |
| 99000 |
|
12 |
12 |
$0.00 |
| 99072 |
|
307 |
278 |
$0.00 |
| 90461 |
|
53 |
51 |
$0.00 |