| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
677 |
571 |
$40K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
38 |
38 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
83 |
79 |
$2K |
| 90620 |
|
12 |
12 |
$2K |
| 92551 |
|
30 |
30 |
$483.00 |
| 90688 |
|
18 |
16 |
$321.12 |
| 99173 |
|
55 |
55 |
$270.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
31 |
31 |
$225.68 |
| 96127 |
|
45 |
45 |
$133.20 |
| 3008F |
|
33 |
32 |
$33.00 |
| 96160 |
|
15 |
15 |
$22.65 |