| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
31 |
25 |
$430.17 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
18 |
15 |
$420.75 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
12 |
$336.60 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
14 |
13 |
$107.58 |
| 90656 |
|
30 |
26 |
$53.28 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
37 |
27 |
$40.00 |
| 99173 |
|
17 |
14 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
31 |
27 |
$0.00 |
| 97802 |
|
14 |
12 |
$0.00 |