| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
667 |
564 |
$33K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
575 |
504 |
$7K |
| 59425 |
|
19 |
14 |
$889.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
33 |
32 |
$621.92 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
162 |
141 |
$551.85 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
35 |
35 |
$410.22 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
15 |
14 |
$396.66 |
| H1003 |
Prenatal care, at-risk enhanced service; education |
23 |
17 |
$326.71 |
| 90658 |
|
64 |
64 |
$189.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
13 |
13 |
$186.81 |
| 92551 |
|
63 |
62 |
$173.55 |
| 90657 |
|
14 |
14 |
$103.95 |
| 90648 |
|
13 |
12 |
$94.50 |
| 90670 |
|
13 |
12 |
$94.50 |
| 81002 |
|
93 |
86 |
$85.34 |
| 85018 |
|
105 |
104 |
$75.25 |
| 90651 |
|
13 |
13 |
$37.80 |
| 81025 |
|
12 |
12 |
$29.40 |
| 99173 |
|
12 |
12 |
$7.50 |