| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
66 |
62 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
67 |
61 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
16 |
16 |
$985.91 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$646.18 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
55 |
54 |
$513.66 |
| D0190 |
|
19 |
19 |
$247.75 |
| 90686 |
|
23 |
23 |
$0.00 |
| 90461 |
|
14 |
13 |
$0.00 |
| 99173 |
|
16 |
16 |
$0.00 |