| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,597 |
1,307 |
$59K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
50 |
24 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
29 |
29 |
$87.07 |
| 90686 |
|
77 |
77 |
$40.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
179 |
174 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
15 |
14 |
$0.00 |
| 99401 |
|
30 |
29 |
$0.00 |