| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
208 |
194 |
$26K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
125 |
123 |
$11K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
227 |
215 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
170 |
167 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$1K |
| T1502 |
Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit |
21 |
20 |
$522.50 |
| 4124F |
|
26 |
25 |
$430.00 |
| 92567 |
|
17 |
16 |
$284.68 |
| 90686 |
|
16 |
16 |
$0.00 |