| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
51 |
51 |
$54.93 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
110 |
101 |
$50.68 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
245 |
241 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
25 |
25 |
$0.00 |
| 90677 |
|
18 |
18 |
$0.00 |
| 90686 |
|
67 |
67 |
$0.00 |
| 90723 |
|
12 |
12 |
$0.00 |
| 99000 |
|
47 |
47 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
221 |
220 |
$0.00 |
| 90461 |
|
81 |
81 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
15 |
15 |
$0.00 |
| 99173 |
|
20 |
20 |
$0.00 |
| 90670 |
|
29 |
29 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
30 |
30 |
$0.00 |
| 90648 |
|
40 |
40 |
$0.00 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
17 |
17 |
$0.00 |
| 81002 |
|
19 |
19 |
$0.00 |