| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90670 |
|
77 |
77 |
$2K |
| 90723 |
|
67 |
67 |
$1K |
| 90686 |
|
63 |
63 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
256 |
238 |
$1K |
| 90647 |
|
29 |
29 |
$636.84 |
| 90685 |
|
26 |
26 |
$570.96 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
97 |
91 |
$486.40 |
| 99173 |
|
126 |
122 |
$432.00 |
| 99188 |
|
12 |
12 |
$155.64 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
25 |
25 |
$120.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$119.60 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
127 |
102 |
$112.40 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
13 |
12 |
$3.04 |
| 99174 |
|
13 |
13 |
$0.00 |