| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
240 |
222 |
$14K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
64 |
64 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 90461 |
|
15 |
15 |
$504.50 |
| 97802 |
|
12 |
12 |
$244.92 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
39 |
38 |
$210.21 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
16 |
12 |
$164.96 |
| 94760 |
|
85 |
68 |
$0.00 |