| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
94 |
86 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
115 |
106 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
179 |
81 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
15 |
15 |
$856.37 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$690.35 |
| 99173 |
|
13 |
13 |
$27.60 |
| 90677 |
|
14 |
14 |
$0.00 |