| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
7,240 |
3,060 |
$86K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,035 |
1,027 |
$84K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,162 |
2,008 |
$81K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
657 |
655 |
$57K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
706 |
665 |
$38K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
341 |
330 |
$27K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
264 |
259 |
$24K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
271 |
246 |
$12K |
| 87428 |
|
262 |
258 |
$8K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
516 |
501 |
$8K |
| 90461 |
|
1,081 |
896 |
$6K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
384 |
184 |
$6K |
| S8301 |
Infection control supplies, not otherwise specified |
372 |
353 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
152 |
120 |
$1K |
| 99429 |
|
41 |
40 |
$1K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
29 |
29 |
$1K |
| 87077 |
|
75 |
74 |
$562.53 |
| 99000 |
|
47 |
46 |
$463.65 |
| 96160 |
|
79 |
75 |
$170.80 |
| 90686 |
|
610 |
610 |
$78.47 |
| 94760 |
|
116 |
108 |
$27.28 |
| G8708 |
Patient not prescribed antibiotic |
15 |
15 |
$0.00 |
| 90680 |
|
28 |
28 |
$0.00 |
| 90696 |
|
13 |
13 |
$0.00 |
| 90671 |
|
77 |
77 |
$0.00 |
| 90670 |
|
150 |
150 |
$0.00 |
| 90633 |
|
65 |
64 |
$0.00 |
| 90715 |
|
15 |
15 |
$0.00 |
| 90734 |
|
14 |
14 |
$0.00 |
| 90710 |
|
14 |
14 |
$0.00 |