| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
187 |
172 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
40 |
38 |
$960.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
31 |
31 |
$720.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
25 |
24 |
$600.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
44 |
44 |
$240.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
40 |
37 |
$150.08 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
28 |
14 |
$35.64 |
| 86580 |
|
34 |
29 |
$22.23 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
42 |
42 |
$0.00 |
| 92551 |
|
59 |
53 |
$0.00 |
| 90686 |
|
15 |
15 |
$0.00 |
| 96127 |
|
22 |
18 |
$0.00 |
| 90698 |
|
13 |
13 |
$0.00 |
| 90680 |
|
18 |
18 |
$0.00 |
| 90685 |
|
16 |
15 |
$0.00 |
| 99173 |
|
59 |
53 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
14 |
14 |
$0.00 |
| 90670 |
|
21 |
21 |
$0.00 |