| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
220 |
199 |
$20K |
| 99442 |
|
82 |
79 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
196 |
133 |
$5K |
| 92552 |
|
107 |
107 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
49 |
49 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
21 |
21 |
$2K |
| 87428 |
|
16 |
15 |
$1K |
| 96160 |
|
14 |
14 |
$350.00 |
| 90461 |
|
15 |
15 |
$290.53 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
14 |
14 |
$186.14 |
| 81002 |
|
35 |
34 |
$97.03 |
| 90674 |
|
26 |
25 |
$34.18 |