| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
280 |
275 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
493 |
493 |
$6K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
191 |
191 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
29 |
29 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
26 |
26 |
$2K |
| 90686 |
|
180 |
180 |
$866.69 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$865.92 |
| 90685 |
|
29 |
29 |
$349.60 |
| 90474 |
|
13 |
13 |
$99.44 |
| 90670 |
|
15 |
15 |
$55.20 |
| 90698 |
|
15 |
15 |
$55.20 |
| 96161 |
|
14 |
13 |
$54.21 |
| 90680 |
|
13 |
13 |
$36.80 |
| 2014F |
|
24 |
24 |
$0.00 |
| 3008F |
|
236 |
235 |
$0.00 |