| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
315 |
304 |
$18K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
41 |
41 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
29 |
28 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
151 |
151 |
$2K |
| 90461 |
|
86 |
86 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$987.12 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
25 |
22 |
$791.43 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
30 |
29 |
$161.70 |
| 99071 |
|
12 |
12 |
$34.92 |
| 97802 |
|
71 |
71 |
$0.00 |
| 90686 |
|
40 |
40 |
$0.00 |
| S9451 |
Exercise classes, non-physician provider, per session |
85 |
85 |
$0.00 |