| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90658 |
|
12 |
12 |
$162.54 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,158 |
2,089 |
$24.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
44 |
39 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
12 |
12 |
$0.00 |
| 92552 |
|
14 |
14 |
$0.00 |
| 99173 |
|
21 |
21 |
$0.00 |
| 99000 |
|
344 |
338 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
625 |
603 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
13 |
$0.00 |
| 90686 |
|
17 |
17 |
$0.00 |