| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
333 |
274 |
$21K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
351 |
320 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
242 |
218 |
$11K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
962 |
291 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
60 |
60 |
$5K |
| 99429 |
|
44 |
44 |
$2K |
| 90461 |
|
258 |
222 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
104 |
47 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
118 |
95 |
$869.88 |
| 99460 |
|
19 |
12 |
$788.33 |
| 87807 |
|
14 |
14 |
$145.42 |
| 90670 |
|
172 |
159 |
$0.00 |
| 90686 |
|
32 |
31 |
$0.00 |
| 90698 |
|
168 |
153 |
$0.00 |
| 90744 |
|
51 |
50 |
$0.00 |
| 90680 |
|
123 |
118 |
$0.00 |