| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
131 |
123 |
$8K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
55 |
54 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
14 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$1K |
| 96127 |
|
32 |
30 |
$150.60 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
114 |
112 |
$149.31 |
| 90670 |
|
13 |
13 |
$143.00 |
| 90648 |
|
12 |
12 |
$132.00 |
| 85018 |
|
32 |
32 |
$92.16 |
| 99173 |
|
33 |
32 |
$80.29 |
| 90461 |
|
40 |
40 |
$41.20 |
| 36416 |
|
33 |
33 |
$36.30 |