| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
28 |
17 |
$272.24 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
60 |
35 |
$253.80 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
86 |
57 |
$178.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
31 |
19 |
$63.45 |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
115 |
75 |
$29.95 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
31 |
18 |
$7.87 |
| 90656 |
|
39 |
23 |
$0.11 |