| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
292 |
256 |
$17K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
58 |
58 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
13 |
13 |
$999.04 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
71 |
71 |
$437.46 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
31 |
27 |
$360.53 |
| 36415 |
Collection of venous blood by venipuncture |
57 |
57 |
$203.10 |
| 81003 |
|
14 |
14 |
$18.27 |
| 90756 |
|
13 |
13 |
$0.11 |
| 90657 |
|
15 |
15 |
$0.00 |