| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
96 |
91 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
50 |
48 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
23 |
23 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
21 |
21 |
$2K |
| 90461 |
|
32 |
32 |
$655.72 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
40 |
40 |
$504.40 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
24 |
24 |
$161.52 |
| 81002 |
|
17 |
17 |
$46.07 |
| 92551 |
|
16 |
16 |
$7.61 |