| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
833 |
833 |
$38K |
| 90688 |
|
2,023 |
2,010 |
$32K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
524 |
524 |
$21K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,860 |
10,085 |
$16K |
| 90686 |
|
1,180 |
1,176 |
$16K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
211 |
211 |
$9K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
195 |
195 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
371 |
364 |
$3K |
| 90651 |
|
195 |
195 |
$2K |
| 90734 |
|
86 |
86 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
25 |
24 |
$818.58 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
68 |
68 |
$787.36 |
| 90649 |
|
91 |
90 |
$744.00 |
| 90670 |
|
12 |
12 |
$119.04 |
| G0008 |
Administration of influenza virus vaccine |
13 |
13 |
$87.57 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
33 |
33 |
$3.82 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
1,042 |
1,036 |
$0.00 |
| 0013A |
|
46 |
46 |
$0.00 |
| 90658 |
|
13 |
13 |
$0.00 |
| 99441 |
|
55 |
54 |
$0.00 |