| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
101 |
95 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
146 |
140 |
$10K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
14 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
44 |
44 |
$1K |
| 90461 |
|
14 |
14 |
$769.21 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
16 |
12 |
$199.56 |
| 94760 |
|
53 |
40 |
$1.54 |