| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
726 |
699 |
$48K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
592 |
583 |
$40K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
387 |
379 |
$24K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
450 |
391 |
$22K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
576 |
542 |
$21K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
867 |
796 |
$14K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,007 |
919 |
$13K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
117 |
110 |
$8K |
| 92551 |
|
682 |
671 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
48 |
48 |
$3K |
| 99173 |
|
714 |
701 |
$1K |
| 99050 |
|
49 |
44 |
$1K |
| 90473 |
|
64 |
64 |
$657.09 |
| 99188 |
|
32 |
12 |
$230.88 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
90 |
80 |
$137.75 |
| 36416 |
|
48 |
46 |
$4.04 |
| 90716 |
|
18 |
18 |
$0.00 |
| 90723 |
|
280 |
261 |
$0.00 |
| 90647 |
|
273 |
251 |
$0.00 |
| 85018 |
|
39 |
39 |
$0.00 |
| 90696 |
|
55 |
43 |
$0.00 |
| 90686 |
|
154 |
154 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
42 |
41 |
$0.00 |
| 90707 |
|
14 |
14 |
$0.00 |
| 90670 |
|
384 |
357 |
$0.00 |
| 90710 |
|
128 |
115 |
$0.00 |
| 90734 |
|
40 |
28 |
$0.00 |
| 90633 |
|
258 |
240 |
$0.00 |
| 90681 |
|
64 |
64 |
$0.00 |
| 90649 |
|
90 |
74 |
$0.00 |
| 90700 |
|
62 |
62 |
$0.00 |