| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
82 |
77 |
$6K |
| 90461 |
|
39 |
39 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16 |
16 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
64 |
64 |
$860.60 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12 |
12 |
$330.16 |
| 90686 |
|
29 |
29 |
$0.00 |