| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 85027 |
|
95 |
95 |
$682.10 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
310 |
309 |
$376.50 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
33 |
32 |
$369.92 |
| 83655 |
|
13 |
13 |
$174.98 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
112 |
100 |
$43.08 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
61 |
61 |
$0.00 |
| 90670 |
|
44 |
44 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
83 |
83 |
$0.00 |
| 99051 |
|
26 |
25 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
75 |
75 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
332 |
311 |
$0.00 |
| 90648 |
|
51 |
51 |
$0.00 |
| 90461 |
|
105 |
105 |
$0.00 |
| 81002 |
|
56 |
56 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
49 |
49 |
$0.00 |
| 99173 |
|
72 |
72 |
$0.00 |
| 90686 |
|
90 |
90 |
$0.00 |
| 99000 |
|
220 |
214 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
100 |
100 |
$0.00 |
| 90677 |
|
12 |
12 |
$0.00 |