| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
313 |
306 |
$17K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$946.28 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
36 |
36 |
$481.92 |
| 90686 |
|
38 |
38 |
$430.61 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
27 |
27 |
$60.77 |
| 99173 |
|
17 |
17 |
$40.36 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
20 |
20 |
$33.18 |
| 99051 |
|
111 |
110 |
$0.00 |
| 90461 |
|
12 |
12 |
$0.00 |