| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
287 |
191 |
$3K |
| 90688 |
|
103 |
102 |
$252.01 |
| 92552 |
|
68 |
67 |
$222.51 |
| 86580 |
|
87 |
84 |
$111.69 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
712 |
595 |
$64.68 |
| 90715 |
|
31 |
30 |
$54.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
24 |
24 |
$43.41 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
16 |
16 |
$35.01 |
| 90658 |
|
13 |
13 |
$18.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
87 |
84 |
$9.37 |
| 81002 |
|
55 |
54 |
$4.71 |
| 97802 |
|
96 |
96 |
$0.00 |
| 3008F |
|
71 |
70 |
$0.00 |
| 90461 |
|
38 |
36 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
18 |
18 |
$0.00 |