| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
9,016 |
5,736 |
$74K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,052 |
2,048 |
$74K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,719 |
1,714 |
$73K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,005 |
1,994 |
$69K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,547 |
12,123 |
$37K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
835 |
826 |
$30K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,660 |
1,633 |
$8K |
| 99383 |
|
44 |
44 |
$3K |
| 99381 |
|
38 |
38 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
42 |
42 |
$2K |
| 90698 |
|
403 |
403 |
$1K |
| 90670 |
|
317 |
315 |
$1K |
| 90716 |
|
289 |
289 |
$619.00 |
| 90680 |
|
167 |
167 |
$617.00 |
| 99173 |
|
168 |
168 |
$402.40 |
| 92552 |
|
24 |
24 |
$249.84 |
| 90697 |
|
28 |
28 |
$246.00 |
| 90744 |
|
95 |
95 |
$229.00 |
| 90707 |
|
152 |
152 |
$185.00 |
| 90633 |
|
133 |
133 |
$138.00 |
| 90651 |
|
155 |
155 |
$70.00 |
| 90685 |
|
30 |
30 |
$40.00 |
| 90715 |
|
35 |
35 |
$27.00 |
| 90686 |
|
170 |
170 |
$20.00 |
| 90688 |
|
12 |
12 |
$10.00 |
| 90700 |
|
13 |
13 |
$9.00 |
| D0120 |
Periodic oral evaluation - established patient |
19 |
19 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
19 |
19 |
$0.00 |
| 97802 |
|
19 |
19 |
$0.00 |
| 99401 |
|
19 |
19 |
$0.00 |