| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
93 |
91 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
31 |
29 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$2K |
| 99188 |
|
50 |
50 |
$426.50 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
25 |
25 |
$0.00 |
| 90461 |
|
21 |
21 |
$0.00 |
| 87430 |
|
69 |
68 |
$0.00 |
| 92551 |
|
54 |
54 |
$0.00 |