| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92081 |
|
746 |
745 |
$27K |
| 92552 |
|
972 |
969 |
$15K |
| 90658 |
|
602 |
590 |
$9K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
111 |
110 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
75 |
75 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
48 |
27 |
$379.76 |
| 99173 |
|
12 |
12 |
$31.84 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,250 |
1,142 |
$0.00 |