| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
186 |
175 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$956.61 |
| 90686 |
|
68 |
68 |
$777.68 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
38 |
16 |
$458.70 |
| 99173 |
|
61 |
60 |
$142.28 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
101 |
100 |
$99.36 |
| 99051 |
|
81 |
75 |
$25.20 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
32 |
30 |
$11.00 |