| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
632 |
575 |
$29K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
45 |
42 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
33 |
33 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
109 |
109 |
$1K |
| 87081 |
|
115 |
111 |
$861.84 |
| 90461 |
|
65 |
65 |
$829.65 |
| 87430 |
|
25 |
25 |
$341.75 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
18 |
16 |
$152.10 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
27 |
27 |
$0.00 |
| 90723 |
|
12 |
12 |
$0.00 |