| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
338 |
331 |
$902.33 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
86 |
85 |
$360.57 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$118.32 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
59 |
56 |
$49.75 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
21 |
21 |
$20.86 |
| 90686 |
|
31 |
31 |
$19.76 |
| 96160 |
|
19 |
19 |
$4.65 |
| 90651 |
|
12 |
12 |
$0.00 |
| 99173 |
|
12 |
12 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$0.00 |