| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,830 |
2,507 |
$13K |
| 86580 |
|
769 |
769 |
$5K |
| 92552 |
|
657 |
657 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
225 |
224 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
307 |
307 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
147 |
145 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
184 |
184 |
$875.60 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,172 |
1,146 |
$843.68 |
| 90686 |
|
273 |
272 |
$333.00 |
| 90674 |
|
86 |
86 |
$235.82 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$231.70 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
41 |
41 |
$181.34 |
| 90633 |
|
52 |
52 |
$72.00 |
| 92081 |
|
492 |
492 |
$68.62 |
| 96127 |
|
150 |
150 |
$66.94 |
| 90672 |
|
26 |
25 |
$54.91 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
30 |
30 |
$51.55 |
| 90648 |
|
12 |
12 |
$36.00 |
| 84443 |
Thyroid stimulating hormone (TSH) |
24 |
24 |
$29.70 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
94 |
94 |
$16.05 |
| 99173 |
|
426 |
425 |
$15.12 |
| 3008F |
|
428 |
428 |
$0.00 |
| 81000 |
|
27 |
27 |
$0.00 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
12 |
12 |
$0.00 |
| 84439 |
|
12 |
12 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$0.00 |