| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96151 |
|
76 |
76 |
$2K |
| 90686 |
|
164 |
164 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
472 |
456 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
18 |
18 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
101 |
96 |
$301.71 |
| 92551 |
|
16 |
16 |
$210.56 |
| 96156 |
|
26 |
26 |
$73.00 |
| G9920 |
Screening performed and negative |
12 |
12 |
$29.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
72 |
72 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
46 |
31 |
$0.00 |
| 99173 |
|
13 |
13 |
$0.00 |