| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
456 |
377 |
$17K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
25 |
25 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
16 |
12 |
$297.60 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
44 |
39 |
$188.30 |
| 83655 |
|
13 |
13 |
$180.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$88.00 |
| 85018 |
|
15 |
15 |
$42.00 |
| 96127 |
|
14 |
14 |
$33.93 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
14 |
13 |
$23.50 |
| 90461 |
|
35 |
32 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
107 |
94 |
$0.00 |
| 99173 |
|
13 |
13 |
$0.00 |