| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,979 |
1,752 |
$95K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
231 |
229 |
$17K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
442 |
431 |
$15K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
147 |
144 |
$10K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,270 |
472 |
$10K |
| 87428 |
|
89 |
85 |
$6K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
158 |
142 |
$5K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
134 |
128 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
57 |
57 |
$5K |
| 90461 |
|
388 |
320 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
24 |
22 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
43 |
42 |
$583.38 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
90 |
76 |
$512.82 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
38 |
18 |
$472.60 |
| 87807 |
|
13 |
12 |
$132.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
15 |
14 |
$79.75 |
| 90686 |
|
18 |
18 |
$19.00 |
| 90680 |
|
14 |
14 |
$0.00 |
| 90698 |
|
28 |
28 |
$0.00 |
| 1170F |
|
45 |
40 |
$0.00 |
| 90744 |
|
12 |
12 |
$0.00 |
| 1125F |
|
13 |
12 |
$0.00 |
| 90670 |
|
136 |
136 |
$0.00 |