| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
586 |
581 |
$22K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
191 |
189 |
$10K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
64 |
64 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
44 |
44 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$544.08 |
| 99177 |
|
100 |
100 |
$219.51 |
| 99173 |
|
12 |
12 |
$19.00 |
| 99072 |
|
285 |
272 |
$0.00 |