| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,378 |
2,459 |
$375K |
| 99199 |
Unlisted special service, procedure or report |
4,009 |
4,008 |
$17K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
255 |
212 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
94 |
74 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
28 |
24 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
34 |
28 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
24 |
13 |
$857.12 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
75 |
66 |
$538.73 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
38 |
19 |
$310.86 |
| 90686 |
|
19 |
15 |
$16.55 |
| 92551 |
|
160 |
111 |
$12.00 |
| 99173 |
|
163 |
114 |
$11.00 |
| 90670 |
|
37 |
24 |
$0.00 |