| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
260 |
240 |
$10K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
128 |
126 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
30 |
29 |
$545.27 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$348.56 |
| 92552 |
|
13 |
13 |
$87.50 |
| 90688 |
|
12 |
12 |
$38.34 |
| 99173 |
|
50 |
50 |
$22.67 |
| 99000 |
|
140 |
136 |
$0.00 |