| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
6,838 |
5,560 |
$241K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,246 |
1,123 |
$95K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,105 |
1,015 |
$93K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
819 |
677 |
$62K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
657 |
564 |
$50K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
882 |
796 |
$26K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
341 |
267 |
$21K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,858 |
1,577 |
$12K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
3,926 |
3,343 |
$11K |
| 81003 |
|
2,893 |
2,502 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
300 |
150 |
$1K |
| 99383 |
|
17 |
17 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
293 |
227 |
$934.30 |
| 99381 |
|
13 |
12 |
$903.65 |
| 90670 |
|
761 |
658 |
$709.68 |
| 36416 |
|
2,308 |
1,738 |
$667.03 |
| 90633 |
|
229 |
204 |
$412.03 |
| 90723 |
|
100 |
99 |
$216.00 |
| 90698 |
|
199 |
168 |
$166.48 |
| 90715 |
|
97 |
97 |
$140.00 |
| 90696 |
|
54 |
54 |
$120.00 |
| 90707 |
|
56 |
54 |
$100.00 |
| 90700 |
|
85 |
85 |
$100.00 |
| 90461 |
|
862 |
658 |
$84.29 |
| 90648 |
|
101 |
100 |
$80.00 |
| 90716 |
|
59 |
57 |
$70.00 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
930 |
648 |
$53.22 |
| 90734 |
|
80 |
79 |
$50.00 |
| 90651 |
|
39 |
26 |
$50.00 |
| 90710 |
|
52 |
52 |
$37.00 |
| 99000 |
|
508 |
386 |
$10.00 |
| 92551 |
|
1,564 |
1,209 |
$10.00 |
| 90744 |
|
128 |
110 |
$10.00 |
| 99173 |
|
1,574 |
1,213 |
$0.00 |
| 90681 |
|
39 |
39 |
$0.00 |
| 90680 |
|
12 |
12 |
$0.00 |
| 90647 |
|
41 |
41 |
$0.00 |