| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
97 |
94 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
138 |
136 |
$7K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
143 |
143 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$960.78 |
| 96127 |
|
17 |
16 |
$49.59 |
| 90686 |
|
13 |
13 |
$0.00 |