| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,134 |
3,815 |
$315K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,221 |
1,147 |
$121K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,649 |
2,636 |
$45K |
| 87428 |
|
273 |
272 |
$13K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
133 |
133 |
$12K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
84 |
84 |
$8K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
136 |
131 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
24 |
24 |
$2K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
69 |
67 |
$2K |
| 87807 |
|
130 |
130 |
$2K |
| 92551 |
|
434 |
433 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
223 |
218 |
$1K |
| 90461 |
|
125 |
125 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$1K |
| 99173 |
|
409 |
409 |
$281.46 |
| 81000 |
|
14 |
14 |
$63.72 |
| 99000 |
|
182 |
174 |
$0.00 |
| 90686 |
|
89 |
89 |
$0.00 |
| 90656 |
|
12 |
12 |
$0.00 |
| 94760 |
|
83 |
64 |
$0.00 |