| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
557 |
465 |
$31K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
107 |
100 |
$8K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
36 |
35 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
30 |
28 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
25 |
25 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
75 |
70 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
54 |
27 |
$708.18 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
155 |
151 |
$493.56 |
| 90461 |
|
85 |
83 |
$359.55 |
| 92551 |
|
12 |
12 |
$117.39 |
| 99173 |
|
13 |
13 |
$28.49 |