| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
211 |
193 |
$18K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
207 |
191 |
$12K |
| 96130 |
|
355 |
343 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
27 |
26 |
$3K |
| 90686 |
|
194 |
194 |
$2K |
| 96127 |
|
309 |
306 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
85 |
79 |
$1K |
| 90672 |
|
15 |
15 |
$212.70 |
| 99188 |
|
25 |
25 |
$191.04 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
43 |
38 |
$158.04 |
| 3008F |
|
15 |
15 |
$110.00 |