| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
125 |
123 |
$9K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
29 |
29 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
27 |
27 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
23 |
23 |
$2K |
| 90461 |
|
29 |
29 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
72 |
72 |
$1K |
| 85018 |
|
12 |
12 |
$25.80 |
| 90686 |
|
14 |
14 |
$0.00 |