| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,717 |
1,638 |
$68K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
197 |
193 |
$11K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
65 |
65 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
56 |
56 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
43 |
41 |
$3K |
| 99173 |
|
59 |
59 |
$452.31 |
| 90686 |
|
122 |
118 |
$411.45 |
| 92551 |
|
30 |
30 |
$296.88 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$137.40 |
| 90656 |
|
13 |
13 |
$0.00 |