| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
121 |
67 |
$222.46 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
53 |
44 |
$75.40 |
| 90686 |
|
42 |
24 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15 |
12 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
66 |
36 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
29 |
15 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
23 |
12 |
$0.00 |