| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
975 |
821 |
$47K |
| 87428 |
|
74 |
69 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
104 |
80 |
$2K |
| 90686 |
|
96 |
87 |
$781.68 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
38 |
12 |
$453.85 |
| 96127 |
|
24 |
24 |
$350.40 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
14 |
14 |
$180.32 |
| 1159F |
|
411 |
329 |
$0.00 |
| 1160F |
|
411 |
329 |
$0.00 |
| 99072 |
|
66 |
53 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
33 |
13 |
$0.00 |
| 3008F |
|
70 |
46 |
$0.00 |