| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90658 |
|
359 |
315 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
302 |
300 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,397 |
3,288 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,899 |
4,579 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
42 |
42 |
$1K |
| 99384 |
|
16 |
16 |
$998.24 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
36 |
36 |
$858.00 |
| 90670 |
|
13 |
13 |
$675.60 |
| 92552 |
|
69 |
67 |
$591.60 |
| 90686 |
|
56 |
53 |
$367.84 |
| 90648 |
|
12 |
12 |
$133.40 |
| 92081 |
|
31 |
31 |
$91.24 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$68.81 |
| 81001 |
|
17 |
17 |
$48.79 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
1,080 |
1,078 |
$41.72 |
| 99406 |
|
949 |
947 |
$39.49 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,534 |
2,343 |
$19.96 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
82 |
81 |
$13.82 |
| 99441 |
|
59 |
56 |
$13.23 |
| 99408 |
|
869 |
862 |
$0.00 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
348 |
347 |
$0.00 |
| 3078F |
|
1,259 |
1,233 |
$0.00 |
| 3077F |
|
116 |
114 |
$0.00 |
| 97803 |
|
33 |
33 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
148 |
147 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
43 |
43 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
18 |
18 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
18 |
17 |
$0.00 |
| 3075F |
|
252 |
249 |
$0.00 |
| 3079F |
|
297 |
293 |
$0.00 |
| 3074F |
|
1,296 |
1,263 |
$0.00 |
| 3080F |
|
96 |
95 |
$0.00 |
| G9604 |
Patient survey results not available |
361 |
361 |
$0.00 |
| 99429 |
|
12 |
12 |
$0.00 |