| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
144 |
136 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16 |
16 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
54 |
54 |
$706.16 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
82 |
80 |
$551.86 |
| 97802 |
|
16 |
16 |
$408.16 |
| 90461 |
|
15 |
15 |
$378.30 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
13 |
13 |
$167.57 |
| 81002 |
|
47 |
47 |
$127.37 |
| 96127 |
|
13 |
13 |
$92.43 |