| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90656 |
|
42 |
42 |
$378.93 |
| 90686 |
|
12 |
12 |
$248.10 |
| 96127 |
|
24 |
24 |
$228.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
592 |
574 |
$185.24 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
334 |
328 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
63 |
63 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
76 |
76 |
$0.00 |
| 99442 |
|
50 |
49 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
26 |
26 |
$0.00 |