| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
93 |
90 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
56 |
51 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
71 |
71 |
$938.12 |
| 96127 |
|
97 |
96 |
$714.82 |
| 96160 |
|
74 |
74 |
$628.31 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
74 |
72 |
$492.56 |
| 90461 |
|
13 |
13 |
$301.91 |
| 81002 |
|
61 |
61 |
$163.11 |
| 90686 |
|
24 |
24 |
$0.00 |