| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
175 |
172 |
$12K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
75 |
75 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
65 |
64 |
$6K |
| 90461 |
|
71 |
71 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
21 |
21 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
16 |
16 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
128 |
128 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
14 |
14 |
$175.89 |
| 85018 |
|
32 |
32 |
$66.65 |
| 90633 |
|
14 |
14 |
$0.00 |
| 90686 |
|
33 |
33 |
$0.00 |