| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
375 |
359 |
$31K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
484 |
440 |
$28K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
41 |
37 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
35 |
34 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
32 |
32 |
$3K |
| 90686 |
|
105 |
105 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
52 |
24 |
$756.60 |
| 95117 |
|
44 |
25 |
$373.68 |
| 90651 |
|
19 |
19 |
$237.73 |
| 90734 |
|
15 |
14 |
$179.98 |
| 90670 |
|
12 |
12 |
$136.40 |
| 85027 |
|
14 |
14 |
$109.90 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
165 |
160 |
$43.20 |
| 90461 |
|
37 |
37 |
$0.00 |