| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
192 |
176 |
$13K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
12 |
$1K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
80 |
76 |
$538.40 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
30 |
30 |
$378.30 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
25 |
25 |
$322.25 |
| 81002 |
|
12 |
12 |
$32.52 |