| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
414 |
353 |
$103K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
59 |
55 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
28 |
28 |
$7K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
136 |
135 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$3K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
15 |
15 |
$1K |
| 90677 |
|
13 |
13 |
$1K |
| 81025 |
|
71 |
69 |
$164.54 |
| 81003 |
|
221 |
172 |
$103.85 |
| 85018 |
|
190 |
190 |
$12.95 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
27 |
27 |
$3.88 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
36 |
28 |
$0.00 |
| 87430 |
|
20 |
20 |
$0.00 |
| 90651 |
|
14 |
14 |
$0.00 |
| 3008F |
|
15 |
12 |
$0.00 |