| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,056 |
1,889 |
$149K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
512 |
487 |
$27K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
568 |
557 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
72 |
70 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
239 |
238 |
$5K |
| 83655 |
|
295 |
284 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
42 |
42 |
$797.77 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
48 |
48 |
$353.72 |
| 90658 |
|
89 |
88 |
$199.02 |
| 99215 |
Prolong outpt/office vis |
13 |
12 |
$113.27 |
| 90668 |
|
167 |
165 |
$0.00 |
| 90686 |
|
130 |
130 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
28 |
28 |
$0.00 |
| 90656 |
|
32 |
32 |
$0.00 |
| Q3014 |
Telehealth originating site facility fee |
51 |
42 |
$0.00 |