| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0071A |
|
184 |
184 |
$7K |
| 0072A |
|
165 |
164 |
$7K |
| 90480 |
|
155 |
154 |
$6K |
| 0004A |
|
93 |
93 |
$4K |
| 0001A |
|
80 |
80 |
$3K |
| 0002A |
|
76 |
76 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
110 |
103 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
113 |
100 |
$2K |
| 90656 |
|
172 |
171 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
114 |
106 |
$2K |
| 0073A |
|
34 |
34 |
$1K |
| 0124A |
|
32 |
32 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
80 |
69 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
404 |
379 |
$1K |
| 90651 |
|
61 |
61 |
$810.50 |
| 90698 |
|
60 |
55 |
$443.58 |
| 90734 |
|
47 |
47 |
$367.04 |
| 90670 |
|
92 |
87 |
$362.44 |
| 90655 |
|
61 |
54 |
$361.58 |
| 92552 |
|
84 |
79 |
$330.97 |
| 90620 |
|
50 |
50 |
$248.16 |
| 83655 |
|
58 |
53 |
$243.33 |
| 90680 |
|
15 |
15 |
$148.80 |
| 90658 |
|
81 |
81 |
$148.18 |
| 90710 |
|
17 |
17 |
$119.04 |
| 90744 |
|
30 |
28 |
$97.36 |
| 90633 |
|
15 |
15 |
$89.28 |
| 85018 |
|
119 |
112 |
$79.80 |
| 92081 |
|
80 |
80 |
$50.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
235 |
226 |
$45.10 |
| 86580 |
|
13 |
13 |
$22.20 |
| 90681 |
|
20 |
20 |
$19.84 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
65 |
65 |
$7.71 |
| 81002 |
|
15 |
13 |
$0.00 |