| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
300 |
260 |
$24K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
250 |
216 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
134 |
125 |
$8K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
29 |
27 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
96 |
42 |
$827.10 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
41 |
35 |
$339.66 |
| 99173 |
|
77 |
70 |
$172.50 |
| 92551 |
|
15 |
14 |
$141.40 |
| 87081 |
|
31 |
26 |
$122.85 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
14 |
12 |
$74.48 |
| 96127 |
|
13 |
12 |
$61.56 |
| 99051 |
|
137 |
125 |
$0.00 |