| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
489 |
454 |
$41K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
67 |
67 |
$9K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
60 |
60 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
58 |
54 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
56 |
56 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
35 |
33 |
$4K |
| 90461 |
|
105 |
105 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
166 |
166 |
$2K |
| 81000 |
|
164 |
162 |
$614.49 |
| 85018 |
|
193 |
193 |
$462.48 |
| 96160 |
|
27 |
27 |
$263.79 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
13 |
13 |
$105.04 |
| 92551 |
|
153 |
153 |
$36.52 |
| 90651 |
|
30 |
30 |
$0.00 |
| 94760 |
|
15 |
13 |
$0.00 |
| 90734 |
|
31 |
31 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| 90670 |
|
25 |
25 |
$0.00 |