| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92586 |
|
115 |
115 |
$737.26 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
57 |
57 |
$581.72 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
38 |
38 |
$567.39 |
| S9470 |
Nutritional counseling, dietitian visit |
58 |
58 |
$430.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
31 |
31 |
$298.25 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
42 |
42 |
$271.26 |
| 83655 |
|
38 |
38 |
$229.94 |
| 90658 |
|
42 |
42 |
$178.05 |
| G9820 |
Documentation of a chlamydia screening test with proper follow-up |
32 |
32 |
$159.00 |
| 99173 |
|
63 |
63 |
$150.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
14 |
$83.72 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
15 |
15 |
$73.95 |
| 36415 |
Collection of venous blood by venipuncture |
110 |
110 |
$37.56 |
| 97802 |
|
23 |
23 |
$32.05 |
| 90461 |
|
17 |
17 |
$0.00 |