| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
213 |
209 |
$20K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
117 |
116 |
$13K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
83 |
81 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
121 |
112 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
163 |
154 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
214 |
210 |
$4K |
| 99188 |
|
103 |
100 |
$2K |
| 96160 |
|
258 |
214 |
$251.38 |
| 85018 |
|
118 |
117 |
$223.24 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
13 |
13 |
$128.96 |
| 81003 |
|
30 |
29 |
$96.13 |
| 90700 |
|
12 |
12 |
$0.00 |
| S9470 |
Nutritional counseling, dietitian visit |
32 |
20 |
$0.00 |
| 99173 |
|
108 |
95 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$0.00 |
| G9920 |
Screening performed and negative |
190 |
180 |
$0.00 |
| 90647 |
|
47 |
45 |
$0.00 |
| D1330 |
|
21 |
21 |
$0.00 |