| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
168 |
161 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
78 |
78 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
83 |
83 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
70 |
70 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
65 |
63 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
33 |
33 |
$2K |
| 90658 |
|
84 |
83 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
196 |
194 |
$682.23 |
| 90633 |
|
36 |
36 |
$646.80 |
| 90707 |
|
28 |
28 |
$454.80 |
| 90716 |
|
28 |
28 |
$454.80 |
| 90647 |
|
20 |
20 |
$303.14 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
143 |
71 |
$275.70 |
| 90670 |
|
16 |
16 |
$227.40 |
| 90681 |
|
15 |
15 |
$227.40 |
| 90649 |
|
13 |
13 |
$220.80 |
| 90657 |
|
13 |
13 |
$220.80 |
| 90723 |
|
14 |
14 |
$209.00 |
| 90696 |
|
12 |
12 |
$184.00 |
| 2014F |
|
99 |
97 |
$0.00 |
| 3008F |
|
175 |
173 |
$0.00 |