| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,542 |
500 |
$49K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,061 |
374 |
$300.70 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
102 |
53 |
$92.70 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
142 |
63 |
$29.40 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
27 |
16 |
$25.22 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
264 |
99 |
$8.00 |
| 85018 |
|
151 |
69 |
$3.78 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
140 |
61 |
$0.02 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
83 |
30 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
25 |
15 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
28 |
12 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
65 |
29 |
$0.00 |
| 36416 |
|
52 |
27 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
60 |
17 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
76 |
31 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
23 |
13 |
$0.00 |
| 90686 |
|
23 |
12 |
$0.00 |