| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
369 |
344 |
$18K |
| 92552 |
|
261 |
259 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
374 |
352 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
25 |
25 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
45 |
45 |
$883.78 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
26 |
26 |
$691.95 |
| 90686 |
|
255 |
254 |
$530.81 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
26 |
13 |
$58.00 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
241 |
239 |
$29.82 |
| 99173 |
|
227 |
226 |
$14.94 |
| 99000 |
|
70 |
70 |
$0.00 |