| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
6,442 |
3,732 |
$37K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
61 |
42 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
20 |
13 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
57 |
38 |
$375.26 |
| 99173 |
|
25 |
17 |
$0.00 |
| G8484 |
Influenza immunization was not administered, reason not given |
19 |
13 |
$0.00 |
| 92551 |
|
25 |
17 |
$0.00 |