| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
630 |
599 |
$10K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
26 |
26 |
$364.00 |
| 87430 |
|
227 |
223 |
$344.30 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
292 |
285 |
$124.05 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
15 |
15 |
$57.80 |
| 85018 |
|
33 |
33 |
$2.05 |
| 81002 |
|
13 |
13 |
$2.00 |
| 92015 |
Determination of refractive state |
15 |
15 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
13 |
13 |
$0.00 |
| 36416 |
|
37 |
36 |
$0.00 |