| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
52 |
50 |
$220.04 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
43 |
41 |
$165.50 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
14 |
13 |
$77.72 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
48 |
22 |
$55.44 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
34 |
34 |
$41.58 |
| 90461 |
|
12 |
12 |
$19.54 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
24 |
17 |
$8.07 |
| 36416 |
|
13 |
12 |
$1.05 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
13 |
13 |
$0.00 |
| 99000 |
|
20 |
20 |
$0.00 |