| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
104 |
98 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
120 |
115 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
50 |
50 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
55 |
54 |
$3K |
| 90698 |
|
79 |
79 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
25 |
25 |
$636.02 |
| 90670 |
|
93 |
93 |
$520.50 |
| 90680 |
|
60 |
60 |
$333.15 |
| 90744 |
|
30 |
30 |
$168.06 |
| 90686 |
|
26 |
26 |
$146.12 |
| 96161 |
|
12 |
12 |
$30.60 |