| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
425 |
387 |
$26K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
13 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
113 |
101 |
$680.67 |
| 99177 |
|
73 |
66 |
$436.61 |
| 90686 |
|
13 |
13 |
$84.04 |
| 99051 |
|
16 |
15 |
$82.46 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
14 |
12 |
$77.90 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
26 |
26 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$0.00 |