| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
107 |
103 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
52 |
50 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
32 |
32 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
15 |
15 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
66 |
66 |
$870.09 |
| 90461 |
|
19 |
19 |
$441.35 |
| 96127 |
|
56 |
56 |
$405.27 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$85.32 |
| 99177 |
|
14 |
14 |
$41.16 |
| 85018 |
|
17 |
17 |
$34.85 |
| 90686 |
|
13 |
13 |
$0.00 |
| 90633 |
|
21 |
21 |
$0.00 |