| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
89 |
89 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
58 |
58 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
156 |
155 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16 |
14 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
29 |
29 |
$581.76 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
13 |
13 |
$457.14 |
| 92551 |
|
77 |
77 |
$416.52 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
125 |
125 |
$210.08 |
| 90688 |
|
79 |
79 |
$92.02 |
| 99173 |
|
31 |
31 |
$77.32 |
| 90670 |
|
12 |
12 |
$27.00 |
| 92081 |
|
34 |
34 |
$16.40 |
| 90461 |
|
13 |
13 |
$0.00 |