| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,162 |
853 |
$46K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
451 |
339 |
$17K |
| 1159F |
|
1,851 |
1,287 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
30 |
26 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
15 |
12 |
$1K |
| 3008F |
|
1,938 |
1,347 |
$991.46 |
| 81003 |
|
235 |
149 |
$379.04 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
33 |
27 |
$362.58 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
30 |
25 |
$190.67 |
| 90686 |
|
19 |
15 |
$120.38 |
| 3074F |
|
89 |
65 |
$91.46 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
14 |
12 |
$85.85 |
| 3078F |
|
39 |
26 |
$40.00 |
| 0502F |
|
156 |
96 |
$0.00 |