| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,509 |
4,909 |
$170K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,272 |
2,252 |
$118K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,894 |
1,857 |
$80K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,362 |
1,361 |
$54K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
849 |
821 |
$48K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
750 |
750 |
$36K |
| 92551 |
|
3,475 |
3,470 |
$33K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
342 |
327 |
$28K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,842 |
3,270 |
$27K |
| 90686 |
|
1,242 |
1,239 |
$11K |
| 90670 |
|
722 |
718 |
$8K |
| 90698 |
|
513 |
511 |
$5K |
| 99215 |
Prolong outpt/office vis |
36 |
36 |
$4K |
| 99173 |
|
2,196 |
2,192 |
$4K |
| 81002 |
|
3,130 |
3,114 |
$3K |
| 90680 |
|
193 |
192 |
$2K |
| 90649 |
|
153 |
153 |
$2K |
| 90710 |
|
85 |
85 |
$1K |
| 94760 |
|
4,376 |
4,042 |
$1K |
| 90461 |
|
1,241 |
1,190 |
$832.00 |
| 90744 |
|
99 |
98 |
$801.00 |
| 90633 |
|
108 |
108 |
$525.35 |
| 0071A |
|
12 |
12 |
$480.00 |
| 0072A |
|
12 |
12 |
$480.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
15 |
15 |
$344.40 |
| 99000 |
|
57 |
54 |
$204.31 |
| 90696 |
|
12 |
12 |
$201.76 |
| 90734 |
|
65 |
65 |
$187.47 |
| 90651 |
|
13 |
13 |
$117.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
21 |
21 |
$56.56 |
| 3078F |
|
34 |
34 |
$20.00 |
| 3074F |
|
34 |
34 |
$20.00 |
| 99401 |
|
24 |
24 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
24 |
24 |
$0.00 |
| 97802 |
|
24 |
24 |
$0.00 |
| 96127 |
|
12 |
12 |
$0.00 |