| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,421 |
3,841 |
$245K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,280 |
1,082 |
$74K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
534 |
419 |
$16K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
197 |
77 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$2K |
| 0012A |
|
12 |
12 |
$488.00 |
| 0011A |
|
12 |
12 |
$480.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
14 |
14 |
$233.20 |
| 92551 |
|
142 |
104 |
$204.97 |
| 90686 |
|
115 |
107 |
$85.53 |
| 36415 |
Collection of venous blood by venipuncture |
136 |
110 |
$55.65 |
| 3078F |
|
550 |
485 |
$0.01 |
| 3008F |
|
1,783 |
1,593 |
$0.00 |
| 3074F |
|
557 |
495 |
$0.00 |
| 1036F |
|
336 |
291 |
$0.00 |
| 3079F |
|
53 |
50 |
$0.00 |
| 91301 |
|
24 |
22 |
$0.00 |
| 92015 |
Determination of refractive state |
113 |
102 |
$0.00 |
| 99173 |
|
15 |
14 |
$0.00 |