| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,552 |
4,852 |
$314K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,836 |
1,420 |
$129K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
265 |
179 |
$14K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
137 |
118 |
$9K |
| 90686 |
|
696 |
599 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
143 |
93 |
$7K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
853 |
297 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,280 |
1,997 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
50 |
46 |
$4K |
| 96127 |
|
650 |
260 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
514 |
249 |
$2K |
| 90670 |
|
45 |
44 |
$1K |
| 90461 |
|
514 |
497 |
$1K |
| 0002A |
|
13 |
13 |
$520.00 |
| 0001A |
|
13 |
12 |
$480.00 |
| 90651 |
|
31 |
27 |
$305.01 |
| 90672 |
|
13 |
13 |
$168.40 |
| 90656 |
|
12 |
12 |
$132.35 |
| 99173 |
|
137 |
60 |
$108.68 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
45 |
45 |
$20.40 |
| 91300 |
|
69 |
65 |
$0.62 |
| 91307 |
|
15 |
15 |
$0.10 |