| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
349 |
301 |
$11K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
100 |
63 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
138 |
122 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
16 |
15 |
$678.37 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
13 |
$533.78 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
30 |
30 |
$430.53 |
| 90461 |
|
16 |
15 |
$0.00 |