| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
526 |
480 |
$27K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
296 |
255 |
$26K |
| 90461 |
|
677 |
315 |
$21K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
513 |
510 |
$15K |
| S9999 |
Sales tax |
1,359 |
1,116 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
94 |
91 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
72 |
72 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
331 |
331 |
$4K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
25 |
25 |
$3K |
| 99080 |
|
428 |
426 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
16 |
16 |
$239.25 |
| 90647 |
|
42 |
42 |
$0.42 |
| 90657 |
|
27 |
27 |
$0.27 |
| 90656 |
|
13 |
13 |
$0.13 |
| 90744 |
|
12 |
12 |
$0.00 |
| 90680 |
|
83 |
83 |
$0.00 |
| 90698 |
|
15 |
15 |
$0.00 |
| 90670 |
|
148 |
148 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |