| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
350 |
324 |
$27K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
68 |
68 |
$8K |
| 90461 |
|
137 |
137 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
295 |
294 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
31 |
31 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
27 |
27 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
28 |
28 |
$831.32 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
26 |
26 |
$212.68 |
| 99177 |
|
37 |
37 |
$190.18 |
| 81003 |
|
36 |
36 |
$74.19 |
| 92552 |
|
65 |
65 |
$71.34 |
| 90686 |
|
126 |
126 |
$0.00 |
| 90670 |
|
26 |
26 |
$0.00 |