| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
114 |
101 |
$11K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
67 |
67 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
128 |
115 |
$9K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
221 |
213 |
$7K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
13 |
13 |
$1K |
| 92552 |
|
36 |
36 |
$745.04 |
| 90480 |
|
16 |
16 |
$340.02 |
| 92551 |
|
16 |
16 |
$135.58 |
| 81002 |
|
12 |
12 |
$27.42 |
| 85018 |
|
14 |
13 |
$25.04 |
| 90686 |
|
137 |
135 |
$0.00 |
| 99172 |
|
49 |
47 |
$0.00 |