| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0001A |
|
944 |
922 |
$31K |
| 0002A |
|
913 |
891 |
$30K |
| 0012A |
|
766 |
737 |
$28K |
| 0031A |
|
770 |
770 |
$27K |
| 0011A |
|
889 |
812 |
$26K |
| 90670 |
|
44 |
41 |
$8K |
| G0008 |
Administration of influenza virus vaccine |
87 |
73 |
$2K |
| 90686 |
|
87 |
73 |
$2K |
| 0003A |
|
42 |
36 |
$1K |
| 99462 |
|
14 |
13 |
$675.00 |
| G0009 |
Administration of pneumococcal vaccine |
49 |
45 |
$504.70 |
| 91303 |
|
242 |
242 |
$0.02 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
445 |
393 |
$0.00 |
| 96160 |
|
386 |
363 |
$0.00 |
| 99442 |
|
32 |
32 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
585 |
518 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
77 |
50 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
311 |
281 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,466 |
1,269 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
34 |
29 |
$0.00 |
| 99401 |
|
52 |
49 |
$0.00 |
| 99409 |
|
12 |
12 |
$0.00 |
| 99408 |
|
12 |
12 |
$0.00 |
| 91300 |
|
16 |
16 |
$0.00 |
| 96127 |
|
655 |
619 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
336 |
253 |
$0.00 |
| 99381 |
|
21 |
13 |
$0.00 |
| 96161 |
|
84 |
84 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
25 |
25 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
12 |
12 |
$0.00 |