| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,129 |
1,014 |
$117K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,847 |
1,604 |
$113K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,556 |
1,542 |
$40K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
202 |
202 |
$15K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
205 |
186 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
61 |
61 |
$5K |
| D0190 |
|
129 |
128 |
$1K |
| 99174 |
|
163 |
163 |
$538.11 |
| 99188 |
|
32 |
32 |
$309.78 |
| 90686 |
|
175 |
175 |
$0.00 |
| 90680 |
|
13 |
13 |
$0.00 |
| 90698 |
|
13 |
13 |
$0.00 |
| 90656 |
|
26 |
26 |
$0.00 |
| 90707 |
|
12 |
12 |
$0.00 |
| 90670 |
|
15 |
15 |
$0.00 |
| 90461 |
|
18 |
18 |
$0.00 |