| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
45 |
40 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
43 |
38 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
125 |
125 |
$408.68 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
72 |
72 |
$352.65 |
| 90688 |
|
12 |
12 |
$36.32 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
51 |
51 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |
| 90698 |
|
24 |
24 |
$0.00 |