| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,875 |
1,033 |
$15K |
| G9920 |
Screening performed and negative |
1,234 |
1,233 |
$12K |
| 96156 |
|
626 |
625 |
$11K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
303 |
302 |
$8K |
| 92552 |
|
1,622 |
1,619 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,056 |
1,022 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
150 |
150 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
631 |
617 |
$3K |
| 99173 |
|
959 |
957 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
17 |
17 |
$858.24 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
91 |
91 |
$589.16 |
| 90686 |
|
933 |
930 |
$504.00 |
| 90670 |
|
25 |
25 |
$108.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
48 |
48 |
$45.92 |
| 90680 |
|
12 |
12 |
$45.00 |
| 90698 |
|
14 |
14 |
$45.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
84 |
83 |
$42.55 |
| 90688 |
|
15 |
15 |
$9.00 |