| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
202 |
187 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
32 |
31 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
12 |
$988.91 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
31 |
29 |
$436.50 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
19 |
17 |
$276.45 |
| 90686 |
|
12 |
12 |
$139.87 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
52 |
52 |
$99.54 |
| 99173 |
|
21 |
21 |
$54.39 |
| 90461 |
|
14 |
14 |
$0.00 |
| 3008F |
|
228 |
204 |
$0.00 |