| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,124 |
1,441 |
$98K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
573 |
501 |
$22K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
308 |
234 |
$21K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
223 |
200 |
$15K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
94 |
85 |
$6K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
318 |
266 |
$6K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
594 |
500 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
367 |
317 |
$2K |
| 96127 |
|
565 |
495 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
15 |
12 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
18 |
12 |
$939.75 |
| 92587 |
|
278 |
245 |
$838.40 |
| 99173 |
|
175 |
155 |
$301.08 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
20 |
14 |
$292.70 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
18 |
12 |
$18.25 |
| 90461 |
|
164 |
144 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
56 |
55 |
$0.00 |
| 90686 |
|
154 |
136 |
$0.00 |