| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
317 |
300 |
$21K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
440 |
437 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
14 |
14 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
13 |
$1K |
| 99177 |
|
140 |
139 |
$500.94 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
94 |
94 |
$191.02 |
| 90686 |
|
68 |
67 |
$105.44 |
| 96127 |
|
14 |
13 |
$43.56 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
40 |
37 |
$0.00 |