| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
351 |
305 |
$57K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
63 |
63 |
$11K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
50 |
50 |
$9K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
41 |
41 |
$7K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
126 |
125 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
15 |
15 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
202 |
200 |
$2K |
| 90461 |
|
49 |
49 |
$2K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
60 |
60 |
$749.17 |
| 92587 |
|
12 |
12 |
$230.50 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
14 |
14 |
$174.07 |
| 85018 |
|
31 |
31 |
$80.46 |
| 90686 |
|
28 |
28 |
$0.00 |