| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
710 |
663 |
$55K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
181 |
146 |
$13K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
166 |
162 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
59 |
48 |
$5K |
| 90686 |
|
158 |
147 |
$2K |
| 90677 |
|
12 |
12 |
$2K |
| 90656 |
|
49 |
45 |
$826.75 |
| 87430 |
|
26 |
26 |
$413.84 |
| 90698 |
|
13 |
12 |
$163.28 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
18 |
17 |
$0.00 |