| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90686 |
|
209 |
158 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
162 |
76 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
228 |
101 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
226 |
149 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
27 |
24 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
28 |
14 |
$859.60 |
| 92552 |
|
60 |
29 |
$330.20 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
61 |
15 |
$315.84 |
| 99173 |
|
28 |
13 |
$13.00 |