| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,788 |
1,609 |
$20K |
| 92552 |
|
1,413 |
1,410 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
214 |
214 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,153 |
1,119 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
119 |
119 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,000 |
2,724 |
$5K |
| 99173 |
|
1,359 |
1,356 |
$3K |
| 90688 |
|
268 |
268 |
$79.00 |
| 90461 |
|
43 |
25 |
$0.00 |
| 90734 |
|
36 |
36 |
$0.00 |
| 90621 |
|
13 |
13 |
$0.00 |