| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
135 |
129 |
$11K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
35 |
35 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
52 |
52 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
31 |
31 |
$3K |
| 90461 |
|
25 |
25 |
$542.23 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
39 |
39 |
$491.79 |
| 96127 |
|
40 |
38 |
$295.59 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$154.68 |
| 90651 |
|
12 |
12 |
$0.00 |
| 99173 |
|
63 |
63 |
$0.00 |
| 99401 |
|
29 |
29 |
$0.00 |