| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
355 |
329 |
$19K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
351 |
327 |
$13K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
865 |
365 |
$12K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
137 |
137 |
$12K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
102 |
99 |
$8K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
80 |
78 |
$7K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
77 |
77 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
134 |
127 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
190 |
133 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
15 |
15 |
$1K |
| 99383 |
|
12 |
12 |
$1K |
| 96380 |
|
49 |
48 |
$915.37 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
64 |
32 |
$778.40 |
| 83655 |
|
41 |
40 |
$396.63 |
| 90380 |
|
15 |
15 |
$0.01 |
| 90648 |
|
13 |
13 |
$0.00 |
| 90710 |
|
27 |
27 |
$0.00 |
| 90681 |
|
20 |
20 |
$0.00 |
| 90633 |
|
38 |
38 |
$0.00 |
| 90677 |
|
118 |
118 |
$0.00 |
| 90656 |
|
79 |
79 |
$0.00 |
| 90647 |
|
46 |
46 |
$0.00 |
| 3008F |
|
12 |
12 |
$0.00 |
| 90723 |
|
77 |
77 |
$0.00 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
79 |
77 |
$0.00 |
| 90381 |
|
18 |
18 |
$0.00 |