| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
264 |
264 |
$10K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,048 |
635 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,093 |
1,010 |
$6K |
| 92551 |
|
578 |
577 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
82 |
82 |
$3K |
| 85018 |
|
691 |
687 |
$1K |
| 99173 |
|
553 |
552 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$420.12 |
| 90686 |
|
19 |
19 |
$21.09 |
| 90461 |
|
12 |
12 |
$16.16 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
69 |
68 |
$0.00 |
| 96127 |
|
15 |
15 |
$0.00 |
| 36416 |
|
16 |
16 |
$0.00 |
| 99174 |
|
13 |
13 |
$0.00 |