| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99215 |
Prolong outpt/office vis |
351 |
313 |
$24K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
126 |
118 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
29 |
27 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
30 |
29 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$576.36 |
| 90656 |
|
30 |
25 |
$511.30 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
27 |
26 |
$437.99 |
| 90686 |
|
14 |
13 |
$238.94 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
44 |
36 |
$0.00 |