| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
316 |
294 |
$19K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
301 |
299 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
12 |
$2K |
| 90686 |
|
103 |
103 |
$832.06 |
| 99177 |
|
87 |
87 |
$547.81 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
111 |
92 |
$448.26 |
| 92551 |
|
24 |
24 |
$174.91 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
61 |
61 |
$0.00 |