| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,659 |
2,548 |
$181K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,000 |
1,756 |
$28K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
442 |
441 |
$27K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
268 |
249 |
$16K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
145 |
145 |
$11K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
89 |
89 |
$6K |
| 90461 |
|
255 |
246 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
41 |
41 |
$3K |
| 81000 |
|
281 |
264 |
$379.04 |
| 86403 |
|
58 |
52 |
$270.52 |
| 90688 |
|
17 |
17 |
$181.84 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
16 |
14 |
$105.64 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
15 |
13 |
$0.00 |