| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
583 |
578 |
$11K |
| 92552 |
|
622 |
622 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
115 |
115 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
98 |
97 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
37 |
37 |
$2K |
| 92081 |
|
232 |
232 |
$800.14 |
| 99173 |
|
273 |
273 |
$717.26 |
| 81002 |
|
422 |
421 |
$703.86 |
| 85018 |
|
93 |
93 |
$191.35 |
| 90707 |
|
16 |
16 |
$90.00 |
| 90670 |
|
13 |
13 |
$63.00 |
| 90698 |
|
13 |
13 |
$54.00 |
| 90688 |
|
26 |
26 |
$36.00 |
| 90649 |
|
26 |
26 |
$34.20 |
| 90734 |
|
13 |
13 |
$18.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
110 |
103 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
41 |
37 |
$0.00 |
| 90633 |
|
15 |
15 |
$0.00 |
| 90461 |
|
16 |
13 |
$0.00 |