| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
72 |
44 |
$580.02 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
94 |
51 |
$291.78 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
72 |
35 |
$242.41 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
22 |
13 |
$155.50 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
24 |
13 |
$41.25 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
43 |
23 |
$22.47 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
32 |
17 |
$19.35 |
| 90461 |
|
21 |
12 |
$0.70 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
23 |
15 |
$0.00 |
| 96127 |
|
96 |
52 |
$0.00 |