| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
76 |
76 |
$858.52 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
198 |
193 |
$374.00 |
| 90461 |
|
29 |
29 |
$271.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
19 |
19 |
$218.65 |
| 92552 |
|
55 |
55 |
$82.32 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
20 |
20 |
$69.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
47 |
47 |
$68.00 |
| 3008F |
|
61 |
61 |
$0.00 |
| 99173 |
|
51 |
51 |
$0.00 |