| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
49 |
48 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
32 |
32 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
16 |
16 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
51 |
51 |
$643.11 |
| 90461 |
|
28 |
28 |
$517.01 |
| 90633 |
|
16 |
16 |
$0.00 |
| 97802 |
|
52 |
52 |
$0.00 |
| 90686 |
|
15 |
15 |
$0.00 |