| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 91322 |
|
274 |
224 |
$27K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
188 |
144 |
$17K |
| 90480 |
|
277 |
225 |
$8K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
418 |
128 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
144 |
121 |
$2K |
| 99384 |
|
14 |
13 |
$2K |
| 90686 |
|
91 |
79 |
$969.35 |
| 92551 |
|
56 |
49 |
$660.28 |
| 90461 |
|
131 |
54 |
$657.07 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
17 |
16 |
$462.19 |
| 0124A |
|
44 |
40 |
$376.63 |
| 96127 |
|
109 |
77 |
$286.58 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
50 |
27 |
$230.78 |
| 99173 |
|
56 |
49 |
$173.83 |
| 90715 |
|
20 |
19 |
$0.00 |
| 91312 |
|
15 |
14 |
$0.00 |
| 90619 |
|
79 |
52 |
$0.00 |
| 90650 |
|
28 |
27 |
$0.00 |