| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
349 |
332 |
$26K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
119 |
111 |
$13K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
117 |
116 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
68 |
34 |
$922.08 |
| 90461 |
|
25 |
25 |
$595.80 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
15 |
15 |
$202.95 |
| 81003 |
|
37 |
36 |
$75.48 |
| 90686 |
|
35 |
35 |
$0.00 |