| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
8,004 |
4,721 |
$60K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,518 |
1,512 |
$60K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,391 |
1,384 |
$46K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,217 |
1,211 |
$40K |
| 92552 |
|
3,702 |
3,686 |
$32K |
| 99173 |
|
3,679 |
3,663 |
$9K |
| 90651 |
|
261 |
258 |
$2K |
| 90621 |
|
158 |
156 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
38 |
38 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,415 |
3,146 |
$205.00 |
| 90658 |
|
757 |
755 |
$172.90 |
| 90686 |
|
470 |
468 |
$148.12 |
| 90734 |
|
56 |
55 |
$109.07 |
| 90685 |
|
68 |
68 |
$0.00 |
| 90461 |
|
149 |
120 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| 90700 |
|
88 |
88 |
$0.00 |
| 90670 |
|
54 |
54 |
$0.00 |
| 90713 |
|
36 |
36 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
132 |
128 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
17 |
15 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
8,630 |
7,722 |
$0.00 |
| 3008F |
|
1,011 |
1,011 |
$0.00 |
| 90619 |
|
15 |
15 |
$0.00 |
| 97802 |
|
13 |
13 |
$0.00 |
| 90657 |
|
80 |
80 |
$0.00 |