| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
48 |
42 |
$7K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
117 |
117 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
29 |
28 |
$3K |
| 92551 |
|
100 |
100 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
19 |
19 |
$526.22 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$432.00 |
| 99173 |
|
57 |
57 |
$130.44 |
| 96127 |
|
14 |
14 |
$58.80 |
| 90686 |
|
24 |
24 |
$20.53 |
| 1126F |
|
40 |
40 |
$0.00 |
| 3008F |
|
191 |
191 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
13 |
12 |
$0.00 |