| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
945 |
844 |
$52K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
80 |
74 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
18 |
16 |
$1K |
| 92552 |
|
42 |
40 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$967.82 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
203 |
193 |
$221.51 |
| 90686 |
|
15 |
15 |
$200.53 |
| 36415 |
Collection of venous blood by venipuncture |
49 |
46 |
$120.06 |
| 99173 |
|
43 |
42 |
$101.01 |