| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
186 |
179 |
$36K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
235 |
225 |
$32K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
259 |
129 |
$13K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
38 |
38 |
$9K |
| 90461 |
|
89 |
26 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
44 |
43 |
$1K |
| 96127 |
|
16 |
16 |
$320.00 |