| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
70 |
68 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
27 |
27 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
71 |
71 |
$895.31 |
| 97802 |
|
33 |
33 |
$841.83 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
82 |
82 |
$551.86 |
| 96127 |
|
63 |
63 |
$455.04 |
| 90461 |
|
15 |
15 |
$378.30 |
| 81002 |
|
47 |
46 |
$127.37 |