| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
395 |
374 |
$22K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17 |
16 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
17 |
15 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
17 |
16 |
$458.09 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
30 |
30 |
$435.12 |
| 90686 |
|
29 |
29 |
$334.74 |
| 92551 |
|
21 |
21 |
$225.47 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
52 |
52 |
$223.02 |
| 90461 |
|
12 |
12 |
$167.00 |
| 99173 |
|
19 |
19 |
$49.21 |