| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,175 |
1,159 |
$45K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
156 |
156 |
$13K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,078 |
1,076 |
$12K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
138 |
138 |
$12K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
84 |
84 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
73 |
73 |
$6K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
485 |
483 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
44 |
43 |
$3K |
| 90686 |
|
376 |
376 |
$2K |
| 90633 |
|
87 |
87 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
62 |
62 |
$1K |
| 90651 |
|
65 |
65 |
$654.40 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
70 |
57 |
$633.92 |
| 90698 |
|
63 |
63 |
$471.50 |
| 90685 |
|
35 |
35 |
$294.40 |
| 99173 |
|
12 |
12 |
$280.00 |
| 90734 |
|
12 |
12 |
$220.80 |
| 96161 |
|
12 |
12 |
$41.70 |
| 90670 |
|
52 |
52 |
$19.93 |
| 2014F |
|
305 |
305 |
$0.00 |
| 3008F |
|
670 |
670 |
$0.00 |