| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
163 |
156 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
15 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
15 |
$2K |
| 97802 |
|
23 |
23 |
$586.73 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
73 |
73 |
$491.29 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
37 |
36 |
$466.57 |
| 90461 |
|
15 |
15 |
$365.69 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$154.68 |
| 81002 |
|
41 |
41 |
$111.11 |
| 96127 |
|
15 |
15 |
$106.65 |