| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
424 |
364 |
$23K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
45 |
44 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
28 |
25 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
93 |
58 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
132 |
129 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 92552 |
|
49 |
48 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$1K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
107 |
103 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
99 |
99 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
46 |
42 |
$563.31 |
| 99173 |
|
36 |
36 |
$442.51 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
21 |
21 |
$373.20 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
16 |
$329.46 |
| 90473 |
|
13 |
13 |
$251.94 |
| 87807 |
|
14 |
14 |
$170.65 |
| 90670 |
|
19 |
19 |
$0.00 |
| 90680 |
|
18 |
18 |
$0.00 |
| 90698 |
|
19 |
19 |
$0.00 |