| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
165 |
164 |
$6K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
145 |
145 |
$5K |
| 90670 |
|
12 |
12 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
28 |
27 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$668.20 |
| 90686 |
|
25 |
25 |
$431.13 |
| 99173 |
|
88 |
88 |
$204.00 |
| 92551 |
|
26 |
26 |
$152.00 |
| 90461 |
|
56 |
56 |
$0.00 |