| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
160 |
151 |
$638.40 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
25 |
25 |
$420.20 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
49 |
48 |
$224.12 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
14 |
13 |
$164.84 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
186 |
105 |
$151.25 |
| 90656 |
|
71 |
71 |
$0.00 |
| 92551 |
|
12 |
12 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
28 |
14 |
$0.00 |