| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
174 |
165 |
$14K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
94 |
47 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
15 |
13 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$2K |
| 87430 |
|
32 |
32 |
$434.56 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
39 |
38 |
$427.65 |
| 87081 |
|
12 |
12 |
$94.44 |