| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
255 |
188 |
$19K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
386 |
260 |
$19K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
148 |
118 |
$13K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
169 |
116 |
$9K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
338 |
127 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
29 |
25 |
$2K |
| 99383 |
|
14 |
12 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
83 |
74 |
$849.84 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
126 |
99 |
$772.70 |
| 87807 |
|
101 |
73 |
$536.57 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
137 |
103 |
$288.75 |
| 99050 |
|
20 |
12 |
$218.28 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
18 |
16 |
$143.64 |
| 90461 |
|
69 |
46 |
$115.50 |
| S9088 |
Services provided in an urgent care center (list in addition to code for service) |
205 |
147 |
$18.00 |
| 36416 |
|
16 |
14 |
$0.00 |