| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
417 |
304 |
$26K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
133 |
117 |
$12K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
119 |
119 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
31 |
31 |
$3K |
| 90474 |
|
62 |
62 |
$867.27 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
25 |
24 |
$718.01 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$161.70 |
| 90680 |
|
60 |
60 |
$0.15 |
| 90670 |
|
93 |
93 |
$0.15 |
| 90698 |
|
54 |
54 |
$0.13 |
| 90633 |
|
14 |
14 |
$0.00 |