| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,129 |
989 |
$63K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
500 |
397 |
$41K |
| 99215 |
Prolong outpt/office vis |
166 |
162 |
$19K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
446 |
435 |
$10K |
| 90461 |
|
205 |
203 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
352 |
339 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
50 |
49 |
$5K |
| 99058 |
|
360 |
338 |
$5K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
185 |
118 |
$4K |
| S9999 |
Sales tax |
442 |
384 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
29 |
29 |
$3K |
| 99205 |
Prolong outpt/office vis |
13 |
13 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$1K |
| 99080 |
|
260 |
251 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
84 |
84 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
32 |
32 |
$859.58 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
29 |
28 |
$451.92 |
| 99070 |
|
50 |
49 |
$447.20 |
| 99442 |
|
12 |
12 |
$234.60 |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
16 |
16 |
$4.42 |
| 90658 |
|
94 |
94 |
$0.00 |
| 90670 |
|
39 |
39 |
$0.00 |
| A6413 |
Adhesive bandage, first-aid type, any size, each |
30 |
30 |
$0.00 |
| 90734 |
|
14 |
14 |
$0.00 |
| 90657 |
|
13 |
13 |
$0.00 |