| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,524 |
1,400 |
$100K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
473 |
223 |
$6K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
57 |
50 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
37 |
37 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
26 |
26 |
$3K |
| 87428 |
|
38 |
36 |
$2K |
| 90461 |
|
27 |
24 |
$877.48 |
| 99050 |
|
12 |
12 |
$479.12 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
39 |
39 |
$456.94 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
49 |
48 |
$429.46 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
34 |
17 |
$414.94 |