| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
27 |
26 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
56 |
41 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
12 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
51 |
51 |
$837.50 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$621.32 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
19 |
19 |
$170.46 |