| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
152 |
152 |
$23K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
154 |
153 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
88 |
84 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
132 |
129 |
$10K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
101 |
101 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
30 |
30 |
$3K |
| 90670 |
|
98 |
98 |
$2K |
| 90686 |
|
106 |
106 |
$2K |
| 90647 |
|
69 |
69 |
$2K |
| 99173 |
|
242 |
242 |
$1K |
| 90723 |
|
49 |
49 |
$1K |
| 90680 |
|
32 |
32 |
$720.00 |
| 92551 |
|
292 |
291 |
$695.84 |
| 96161 |
|
71 |
71 |
$548.10 |
| 90633 |
|
24 |
24 |
$540.00 |
| 90734 |
|
14 |
13 |
$270.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
40 |
40 |
$117.19 |
| 99177 |
|
12 |
12 |
$105.00 |
| 96127 |
|
28 |
28 |
$45.00 |
| 96160 |
|
44 |
44 |
$0.00 |