| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,436 |
1,324 |
$100K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,477 |
1,144 |
$34K |
| 90461 |
|
378 |
356 |
$16K |
| 92587 |
|
483 |
483 |
$10K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
712 |
678 |
$9K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
83 |
83 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
76 |
67 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
41 |
41 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$1K |
| S9999 |
Sales tax |
77 |
66 |
$669.72 |
| 99173 |
|
12 |
12 |
$360.00 |
| 99177 |
|
17 |
17 |
$110.73 |
| 85014 |
|
15 |
15 |
$35.05 |
| 90686 |
|
91 |
91 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |