| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
621 |
581 |
$32K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
14 |
$972.32 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$885.58 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
22 |
12 |
$382.60 |
| 90686 |
|
13 |
13 |
$88.35 |
| 90670 |
|
12 |
12 |
$71.74 |
| 90648 |
|
12 |
12 |
$71.74 |