| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
559 |
520 |
$32K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
108 |
107 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
68 |
68 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
21 |
21 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
13 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
70 |
68 |
$988.02 |
| 90670 |
|
77 |
77 |
$926.25 |
| 90686 |
|
59 |
59 |
$707.22 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
36 |
17 |
$523.80 |
| 90688 |
|
15 |
15 |
$183.94 |
| 36415 |
Collection of venous blood by venipuncture |
57 |
55 |
$159.39 |
| 90723 |
|
12 |
12 |
$147.74 |
| 90710 |
|
12 |
12 |
$147.19 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
192 |
191 |
$23.10 |
| 90461 |
|
92 |
91 |
$0.00 |