| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
834 |
795 |
$18K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
185 |
185 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
141 |
141 |
$13K |
| 92587 |
|
380 |
378 |
$9K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
412 |
401 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
84 |
84 |
$6K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
489 |
487 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
58 |
58 |
$4K |
| 90633 |
|
155 |
155 |
$3K |
| 82948 |
|
474 |
474 |
$2K |
| 90649 |
|
58 |
58 |
$1K |
| 90734 |
|
54 |
54 |
$993.60 |
| 90698 |
|
53 |
53 |
$975.20 |
| 90670 |
|
43 |
43 |
$791.20 |
| 90686 |
|
38 |
38 |
$699.20 |
| 90680 |
|
25 |
25 |
$460.00 |
| 90715 |
|
24 |
24 |
$441.60 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
24 |
24 |
$397.20 |
| 90620 |
|
13 |
13 |
$239.20 |
| 90707 |
|
12 |
12 |
$220.80 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
164 |
164 |
$29.90 |
| 2014F |
|
425 |
425 |
$0.00 |
| 1000F |
|
92 |
92 |
$0.00 |
| 3008F |
|
524 |
524 |
$0.00 |