| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
191 |
174 |
$13K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
13 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
73 |
73 |
$909.81 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
40 |
17 |
$422.35 |
| 90461 |
|
17 |
17 |
$304.53 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$146.40 |
| 90686 |
|
39 |
39 |
$0.00 |