| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
169 |
164 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
55 |
55 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
44 |
42 |
$2K |
| 90686 |
|
41 |
41 |
$689.47 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$675.48 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$616.80 |
| 99173 |
|
101 |
101 |
$230.40 |
| 92551 |
|
14 |
14 |
$85.12 |
| 90461 |
|
64 |
61 |
$0.00 |