| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
212 |
208 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
113 |
113 |
$898.96 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
59 |
59 |
$533.28 |
| 90686 |
|
59 |
59 |
$250.03 |
| A4550 |
Surgical trays |
103 |
63 |
$156.00 |
| 99070 |
|
336 |
115 |
$125.25 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
58 |
57 |
$0.00 |