| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,727 |
5,100 |
$566K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,440 |
3,160 |
$218K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
680 |
632 |
$64K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
623 |
600 |
$60K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
557 |
539 |
$52K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
547 |
504 |
$51K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
424 |
412 |
$10K |
| 90461 |
|
129 |
128 |
$5K |
| 90686 |
|
348 |
340 |
$5K |
| 90670 |
|
200 |
187 |
$4K |
| S9999 |
Sales tax |
562 |
508 |
$4K |
| 90734 |
|
38 |
38 |
$3K |
| 90621 |
|
26 |
26 |
$3K |
| 90651 |
|
58 |
42 |
$3K |
| 90716 |
|
17 |
17 |
$2K |
| 90698 |
|
41 |
41 |
$2K |
| 90655 |
|
115 |
113 |
$1K |
| 90707 |
|
18 |
18 |
$1K |
| 90633 |
|
63 |
53 |
$828.82 |
| 90696 |
|
12 |
12 |
$731.76 |
| 86403 |
|
61 |
60 |
$716.21 |
| 99174 |
|
54 |
53 |
$525.15 |
| 90710 |
|
58 |
46 |
$488.00 |
| 90715 |
|
12 |
12 |
$415.20 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
26 |
24 |
$374.59 |
| 90680 |
|
26 |
26 |
$48.90 |
| 90620 |
|
12 |
12 |
$1.10 |