| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
245 |
212 |
$13K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
18 |
18 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
31 |
29 |
$377.20 |
| 92552 |
|
14 |
14 |
$312.00 |
| 90686 |
|
22 |
21 |
$187.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$145.50 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
78 |
76 |
$143.00 |
| 85018 |
|
51 |
50 |
$132.48 |