| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92551 |
|
369 |
369 |
$121.20 |
| 90674 |
|
31 |
31 |
$81.39 |
| 99383 |
|
51 |
51 |
$54.28 |
| 86580 |
|
101 |
100 |
$16.65 |
| 3078F |
|
722 |
668 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
206 |
192 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$0.00 |
| 1159F |
|
224 |
220 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
96 |
96 |
$0.00 |
| 90670 |
|
128 |
127 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
89 |
89 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
15 |
$0.00 |
| 99172 |
|
331 |
331 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
156 |
155 |
$0.00 |
| 99384 |
|
26 |
26 |
$0.00 |
| 3008F |
|
640 |
615 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
51 |
51 |
$0.00 |
| 3074F |
|
740 |
685 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
148 |
127 |
$0.00 |
| 90698 |
|
94 |
93 |
$0.00 |
| 90744 |
|
31 |
30 |
$0.00 |
| 90686 |
|
64 |
63 |
$0.00 |
| 90680 |
|
38 |
37 |
$0.00 |