| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,768 |
1,609 |
$65K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
731 |
423 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
80 |
80 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
110 |
105 |
$5K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
105 |
100 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
24 |
24 |
$2K |
| 87428 |
|
16 |
16 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
34 |
34 |
$946.59 |
| 0001A |
|
19 |
18 |
$736.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
18 |
18 |
$313.15 |
| 90686 |
|
215 |
215 |
$243.05 |
| 96127 |
|
127 |
127 |
$0.00 |
| 0011A |
|
18 |
17 |
$0.00 |
| 0012A |
|
17 |
17 |
$0.00 |
| 99401 |
|
31 |
30 |
$0.00 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
12 |
12 |
$0.00 |
| 90672 |
|
17 |
17 |
$0.00 |
| 90461 |
|
17 |
13 |
$0.00 |