| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
216 |
192 |
$16K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
112 |
108 |
$12K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
53 |
53 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
32 |
32 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
19 |
18 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
152 |
151 |
$2K |
| 90461 |
|
80 |
80 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$2K |
| 96127 |
|
86 |
85 |
$624.35 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
22 |
21 |
$283.58 |
| 99188 |
|
12 |
12 |
$194.40 |
| 96161 |
|
15 |
15 |
$122.10 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$85.32 |
| 85018 |
|
14 |
14 |
$28.70 |
| 90633 |
|
28 |
28 |
$0.00 |
| 90686 |
|
42 |
42 |
$0.00 |
| 90744 |
|
13 |
12 |
$0.00 |