| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
183 |
162 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
41 |
38 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16 |
16 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
16 |
16 |
$431.92 |
| 90686 |
|
116 |
115 |
$385.72 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
17 |
13 |
$376.86 |
| Q3014 |
Telehealth originating site facility fee |
17 |
14 |
$358.71 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
13 |
12 |
$69.86 |
| 90648 |
|
34 |
27 |
$58.97 |
| 90670 |
|
17 |
13 |
$27.68 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
14 |
12 |
$0.00 |
| 99173 |
|
21 |
17 |
$0.00 |
| 3078F |
|
21 |
15 |
$0.00 |
| 92551 |
|
21 |
17 |
$0.00 |
| 3008F |
|
92 |
78 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
15 |
$0.00 |
| 3074F |
|
22 |
16 |
$0.00 |