| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
132 |
131 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
36 |
36 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
18 |
18 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16 |
16 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
13 |
13 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
12 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15 |
15 |
$1K |
| 80061 |
Lipid panel |
56 |
45 |
$843.54 |
| 85018 |
|
77 |
77 |
$255.36 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
15 |
15 |
$241.78 |
| 96160 |
|
51 |
51 |
$180.81 |
| 96127 |
|
37 |
37 |
$178.91 |
| 92551 |
|
13 |
13 |
$85.19 |
| 90686 |
|
65 |
60 |
$20.17 |
| 36416 |
|
109 |
93 |
$10.60 |
| 90651 |
|
13 |
13 |
$0.00 |
| 99173 |
|
12 |
12 |
$0.00 |
| 90670 |
|
13 |
13 |
$0.00 |