| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
176 |
153 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
61 |
44 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
59 |
56 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
103 |
94 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
46 |
43 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
26 |
26 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
159 |
111 |
$986.71 |
| 96127 |
|
229 |
156 |
$898.40 |
| 92587 |
|
20 |
19 |
$144.00 |
| 99177 |
|
43 |
39 |
$120.21 |
| 96161 |
|
59 |
42 |
$110.68 |
| 96160 |
|
39 |
36 |
$109.92 |
| 90658 |
|
36 |
34 |
$19.63 |
| 90461 |
|
78 |
65 |
$0.00 |
| 36416 |
|
18 |
14 |
$0.00 |
| 90698 |
|
21 |
14 |
$0.00 |