| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
36,108 |
24,716 |
$2.49M |
| 99199 |
Unlisted special service, procedure or report |
63,146 |
23,502 |
$296K |
| 87428 |
|
1,499 |
1,211 |
$63K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
5,000 |
1,545 |
$41K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
2,526 |
1,867 |
$29K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
133 |
85 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
204 |
178 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
85 |
61 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
449 |
261 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
103 |
55 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
227 |
122 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
105 |
55 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
16 |
12 |
$883.63 |
| 92551 |
|
162 |
92 |
$9.27 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
135 |
53 |
$8.75 |
| 99173 |
|
175 |
97 |
$1.00 |
| 90670 |
|
65 |
30 |
$0.00 |