| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,478 |
3,098 |
$207K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,741 |
1,503 |
$143K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,927 |
1,796 |
$23K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
202 |
191 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
115 |
111 |
$10K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
470 |
449 |
$9K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
108 |
104 |
$8K |
| 90686 |
|
874 |
779 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
26 |
26 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$1K |
| 0072A |
|
31 |
27 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
147 |
139 |
$786.80 |
| 0071A |
|
34 |
23 |
$622.00 |
| 90670 |
|
116 |
112 |
$447.41 |
| 0001A |
|
15 |
13 |
$378.00 |
| 90658 |
|
53 |
49 |
$319.02 |
| 92551 |
|
31 |
31 |
$234.91 |
| 90474 |
|
26 |
24 |
$203.41 |
| 90648 |
|
107 |
104 |
$196.14 |
| 94760 |
|
40 |
31 |
$135.51 |
| G0008 |
Administration of influenza virus vaccine |
24 |
22 |
$61.71 |
| 99177 |
|
12 |
12 |
$31.72 |
| 90723 |
|
31 |
29 |
$0.00 |
| 90680 |
|
30 |
29 |
$0.00 |
| 91307 |
|
52 |
45 |
$0.00 |
| 91300 |
|
20 |
15 |
$0.00 |
| 90633 |
|
35 |
34 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |