| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
484 |
375 |
$36K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
464 |
396 |
$24K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
60 |
42 |
$5K |
| 90686 |
|
245 |
216 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
24 |
14 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15 |
13 |
$1K |
| 90677 |
|
16 |
12 |
$1K |
| 90656 |
|
48 |
44 |
$820.72 |
| 99173 |
|
15 |
15 |
$111.75 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
173 |
136 |
$0.00 |