| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
310 |
293 |
$64K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
159 |
156 |
$24K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
13 |
13 |
$607.60 |