| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90670 |
|
526 |
523 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,386 |
2,167 |
$1K |
| 90698 |
|
315 |
315 |
$770.07 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
787 |
785 |
$669.86 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
350 |
350 |
$480.76 |
| 99381 |
|
115 |
115 |
$403.92 |
| 90680 |
|
171 |
171 |
$399.15 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
738 |
738 |
$347.28 |
| 99382 |
|
27 |
26 |
$269.05 |
| 90744 |
|
240 |
238 |
$262.23 |
| 90651 |
|
294 |
291 |
$223.62 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
55 |
55 |
$216.98 |
| 92551 |
|
1,769 |
1,758 |
$202.14 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
753 |
746 |
$189.00 |
| 90686 |
|
632 |
604 |
$132.78 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
397 |
382 |
$104.72 |
| 90674 |
|
164 |
164 |
$81.39 |
| 90633 |
|
302 |
299 |
$72.00 |
| 90710 |
|
360 |
358 |
$63.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
485 |
485 |
$54.28 |
| 99383 |
|
12 |
12 |
$54.28 |
| 90685 |
|
120 |
118 |
$36.00 |
| 90700 |
|
132 |
129 |
$36.00 |
| 86580 |
|
319 |
313 |
$13.32 |
| 90715 |
|
144 |
142 |
$9.00 |
| 90648 |
|
87 |
87 |
$9.00 |
| 90734 |
|
302 |
299 |
$9.00 |
| 90696 |
|
172 |
172 |
$9.00 |
| 90621 |
|
148 |
146 |
$0.00 |
| 81002 |
|
26 |
26 |
$0.00 |
| 97803 |
|
242 |
226 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
260 |
259 |
$0.00 |
| 3078F |
|
3,445 |
3,225 |
$0.00 |
| 99173 |
|
39 |
39 |
$0.00 |
| 1159F |
|
1,429 |
1,379 |
$0.00 |
| 90658 |
|
16 |
16 |
$0.00 |
| 3288F |
|
47 |
47 |
$0.00 |
| 90655 |
|
16 |
16 |
$0.00 |
| 90688 |
|
16 |
16 |
$0.00 |
| 3079F |
|
201 |
197 |
$0.00 |
| 3008F |
|
3,499 |
3,335 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,058 |
996 |
$0.00 |
| 81005 |
|
16 |
13 |
$0.00 |
| 3074F |
|
3,539 |
3,304 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
21 |
15 |
$0.00 |
| 99172 |
|
1,463 |
1,463 |
$0.00 |
| 81000 |
|
16 |
13 |
$0.00 |
| 3075F |
|
39 |
38 |
$0.00 |