| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99215 |
Prolong outpt/office vis |
1,081 |
1,031 |
$89K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,406 |
1,302 |
$83K |
| 99350 |
Prolong home eval add 15m |
831 |
717 |
$20K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
176 |
138 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
505 |
494 |
$4K |
| 99443 |
|
176 |
152 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$860.34 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$549.48 |
| 99442 |
|
13 |
13 |
$245.41 |
| 90658 |
|
35 |
35 |
$0.00 |