| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
144 |
125 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
48 |
47 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
27 |
27 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$1K |
| 97802 |
|
42 |
42 |
$1K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
83 |
83 |
$545.13 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
35 |
35 |
$441.35 |
| 90461 |
|
12 |
12 |
$226.98 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
15 |
14 |
$193.35 |
| 96127 |
|
17 |
17 |
$106.65 |
| 87070 |
|
14 |
14 |
$104.44 |
| 82465 |
|
13 |
13 |
$45.36 |
| 81003 |
|
23 |
22 |
$44.62 |