| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,494 |
5,199 |
$334K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
820 |
768 |
$72K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,889 |
2,870 |
$55K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
452 |
449 |
$45K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,763 |
1,755 |
$43K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
178 |
170 |
$16K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
142 |
141 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
27 |
27 |
$3K |
| 90473 |
|
25 |
25 |
$462.96 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
27 |
27 |
$366.61 |
| 90686 |
|
1,026 |
1,024 |
$340.60 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
15 |
15 |
$102.00 |
| 87081 |
|
12 |
12 |
$80.96 |
| 90723 |
|
127 |
127 |
$0.00 |
| 90680 |
|
24 |
24 |
$0.00 |
| 90647 |
|
91 |
91 |
$0.00 |
| 96161 |
|
13 |
13 |
$0.00 |
| 90670 |
|
253 |
253 |
$0.00 |