| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
35 |
27 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
39 |
36 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
45 |
42 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
15 |
$595.35 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
14 |
$412.74 |
| 90671 |
|
19 |
16 |
$0.00 |
| 90461 |
|
21 |
18 |
$0.00 |
| 90698 |
|
17 |
14 |
$0.00 |