| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
201 |
177 |
$15K |
| 90686 |
|
59 |
59 |
$429.75 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
263 |
263 |
$396.54 |
| 90672 |
|
46 |
46 |
$258.46 |
| 85018 |
|
172 |
170 |
$187.11 |
| 81000 |
|
53 |
51 |
$24.49 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
37 |
37 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
27 |
27 |
$0.00 |
| 90473 |
|
38 |
38 |
$0.00 |
| 99173 |
|
15 |
15 |
$0.00 |