| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96156 |
|
127 |
127 |
$3K |
| 96151 |
|
63 |
63 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
26 |
26 |
$1K |
| 90686 |
|
137 |
137 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$848.76 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$678.84 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
291 |
282 |
$422.16 |
| 96150 |
|
17 |
17 |
$279.12 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
167 |
163 |
$260.80 |
| G9920 |
Screening performed and negative |
116 |
116 |
$174.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
13 |
13 |
$21.40 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
33 |
33 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
60 |
60 |
$0.00 |
| 90461 |
|
14 |
13 |
$0.00 |