| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
45 |
45 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
56 |
56 |
$2K |
| 92552 |
|
108 |
108 |
$991.92 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
30 |
30 |
$938.40 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
99 |
64 |
$392.30 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
103 |
103 |
$381.04 |
| 99173 |
|
69 |
69 |
$175.16 |
| 92015 |
Determination of refractive state |
36 |
36 |
$7.19 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
281 |
253 |
$0.00 |
| 90686 |
|
12 |
12 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |
| 90707 |
|
12 |
12 |
$0.00 |