| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
336 |
334 |
$15K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,642 |
939 |
$13K |
| 92552 |
|
1,019 |
1,016 |
$10K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
227 |
225 |
$8K |
| 99173 |
|
990 |
988 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
66 |
60 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
622 |
572 |
$1K |
| 96156 |
|
13 |
13 |
$908.16 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$221.20 |
| 90686 |
|
254 |
253 |
$9.00 |
| 90649 |
|
13 |
13 |
$0.00 |
| 90688 |
|
16 |
16 |
$0.00 |