| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
408 |
380 |
$30K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
246 |
237 |
$27K |
| 90461 |
|
116 |
115 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
192 |
190 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
16 |
16 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
14 |
14 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
64 |
29 |
$867.84 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
45 |
45 |
$622.39 |
| 81003 |
|
128 |
128 |
$261.12 |
| 85018 |
|
90 |
90 |
$193.50 |
| 90633 |
|
12 |
12 |
$0.00 |
| 90686 |
|
83 |
83 |
$0.00 |