| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
68 |
62 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
75 |
67 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
177 |
123 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
90 |
53 |
$526.39 |
| 99199 |
Unlisted special service, procedure or report |
170 |
170 |
$472.80 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
17 |
13 |
$368.10 |
| 92551 |
|
73 |
55 |
$259.14 |
| 90686 |
|
47 |
38 |
$234.42 |
| 99173 |
|
102 |
83 |
$175.40 |