| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
356 |
355 |
$15K |
| 92552 |
|
1,593 |
1,590 |
$13K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
355 |
354 |
$13K |
| 99384 |
|
278 |
278 |
$11K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
159 |
157 |
$10K |
| 99383 |
|
295 |
295 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,300 |
1,288 |
$8K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
673 |
607 |
$6K |
| 99173 |
|
1,565 |
1,562 |
$3K |
| 83655 |
|
155 |
154 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
59 |
59 |
$2K |
| 83026 |
|
666 |
664 |
$2K |
| 99382 |
|
56 |
54 |
$2K |
| 81003 |
|
558 |
557 |
$1K |
| G9920 |
Screening performed and negative |
91 |
89 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
824 |
749 |
$393.96 |
| 90686 |
|
441 |
438 |
$218.25 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
506 |
498 |
$104.13 |
| 3008F |
|
129 |
121 |
$54.00 |
| 90649 |
|
44 |
44 |
$36.00 |
| 90700 |
|
13 |
12 |
$34.20 |
| 90651 |
|
49 |
49 |
$26.10 |
| 90734 |
|
140 |
140 |
$25.65 |
| 90707 |
|
37 |
37 |
$25.65 |
| 90620 |
|
26 |
26 |
$9.00 |
| 99215 |
Prolong outpt/office vis |
19 |
19 |
$0.00 |
| 90670 |
|
13 |
13 |
$0.00 |
| 90713 |
|
12 |
12 |
$0.00 |
| 90715 |
|
35 |
35 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
26 |
26 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |
| 90633 |
|
30 |
29 |
$0.00 |
| 90716 |
|
26 |
26 |
$0.00 |