| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
24 |
14 |
$1K |
| 96151 |
|
26 |
26 |
$475.60 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17 |
12 |
$444.04 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
58 |
58 |
$258.68 |
| 90670 |
|
12 |
12 |
$99.00 |
| 90647 |
|
13 |
13 |
$99.00 |
| 90723 |
|
12 |
12 |
$99.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
39 |
39 |
$0.00 |