| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
628 |
591 |
$20K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
222 |
219 |
$5K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
107 |
106 |
$5K |
| 92551 |
|
47 |
47 |
$472.74 |
| 90686 |
|
79 |
79 |
$460.69 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$382.92 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$329.52 |
| 90461 |
|
14 |
13 |
$205.00 |
| 99173 |
|
79 |
78 |
$11.24 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
67 |
67 |
$0.00 |