| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,328 |
1,248 |
$90K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
258 |
242 |
$27K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
25 |
25 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
107 |
74 |
$1K |
| 87428 |
|
13 |
13 |
$679.50 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
66 |
60 |
$609.36 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
52 |
25 |
$562.44 |
| 99050 |
|
14 |
14 |
$330.10 |