| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
213 |
196 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
68 |
61 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
23 |
17 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
17 |
16 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
17 |
15 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
225 |
199 |
$363.00 |
| 90670 |
|
29 |
27 |
$311.85 |
| 90656 |
|
16 |
16 |
$286.65 |
| 90716 |
|
19 |
13 |
$251.12 |
| 90633 |
|
20 |
14 |
$180.05 |
| 90698 |
|
13 |
12 |
$138.60 |
| 90461 |
|
80 |
69 |
$99.00 |
| 99173 |
|
41 |
25 |
$59.57 |
| 94760 |
|
18 |
18 |
$0.00 |