| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
370 |
318 |
$31K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
74 |
74 |
$9K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
60 |
59 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
28 |
28 |
$3K |
| 90461 |
|
103 |
103 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
140 |
140 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
14 |
$2K |
| 81000 |
|
77 |
75 |
$290.29 |
| 85018 |
|
110 |
110 |
$265.68 |
| 96160 |
|
19 |
19 |
$185.63 |
| 83655 |
|
14 |
14 |
$176.26 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
20 |
19 |
$161.60 |
| 90633 |
|
12 |
12 |
$0.00 |
| 90670 |
|
37 |
37 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |
| 92551 |
|
71 |
71 |
$0.00 |
| 90698 |
|
18 |
18 |
$0.00 |
| 90680 |
|
16 |
16 |
$0.00 |