| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
17 |
12 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
109 |
75 |
$781.14 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17 |
17 |
$730.64 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
17 |
13 |
$305.56 |
| 99173 |
|
14 |
12 |
$56.44 |