| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
818 |
701 |
$45K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
50 |
32 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
108 |
52 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
112 |
106 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
17 |
15 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
132 |
113 |
$1K |
| 99177 |
|
183 |
134 |
$592.38 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
64 |
63 |
$558.06 |
| 92551 |
|
77 |
47 |
$474.15 |
| 90686 |
|
49 |
37 |
$438.14 |
| 87081 |
|
47 |
47 |
$297.10 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
158 |
133 |
$242.55 |
| 90461 |
|
59 |
49 |
$173.25 |
| 36416 |
|
143 |
99 |
$17.54 |
| 94760 |
|
138 |
112 |
$2.82 |
| 99051 |
|
13 |
13 |
$0.00 |