| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
253 |
248 |
$21K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
349 |
338 |
$20K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
148 |
96 |
$3K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
136 |
136 |
$1K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
29 |
29 |
$778.94 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
68 |
68 |
$615.40 |
| 99050 |
|
28 |
28 |
$463.68 |
| 96127 |
|
37 |
37 |
$379.99 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
13 |
13 |
$307.06 |
| 36416 |
|
24 |
24 |
$240.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
16 |
16 |
$188.96 |
| 87081 |
|
14 |
14 |
$95.76 |
| 81003 |
|
13 |
13 |
$30.03 |