| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
109 |
99 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
14 |
14 |
$744.96 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$415.58 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
13 |
$212.88 |