| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
126 |
125 |
$13K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
90 |
90 |
$6K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
170 |
84 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
51 |
50 |
$657.39 |
| 90461 |
|
21 |
21 |
$466.57 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
29 |
29 |
$365.69 |