| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
153 |
141 |
$9K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
37 |
37 |
$756.65 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
12 |
12 |
$340.45 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
12 |
12 |
$108.60 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
12 |
12 |
$82.20 |
| ATP03 |
|
12 |
12 |
$82.20 |
| 90686 |
|
25 |
25 |
$19.58 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
49 |
43 |
$0.00 |