| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
275 |
257 |
$25K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
83 |
81 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
14 |
14 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
14 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
121 |
121 |
$1K |
| 90686 |
|
48 |
48 |
$361.82 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
48 |
48 |
$165.44 |
| 90647 |
|
12 |
12 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |