| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
319 |
312 |
$25K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
182 |
181 |
$17K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
168 |
168 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
362 |
350 |
$13K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
185 |
172 |
$10K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
30 |
30 |
$3K |
| 90670 |
|
225 |
223 |
$3K |
| 90686 |
|
215 |
214 |
$2K |
| 90723 |
|
161 |
159 |
$2K |
| 90680 |
|
121 |
119 |
$1K |
| 90647 |
|
76 |
76 |
$784.50 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$123.60 |
| 92551 |
|
353 |
353 |
$8.24 |
| 96127 |
|
43 |
43 |
$4.12 |
| 99173 |
|
142 |
142 |
$0.00 |
| 99177 |
|
24 |
24 |
$0.00 |
| 83655 |
|
50 |
50 |
$0.00 |