| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,251 |
1,810 |
$99K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,108 |
957 |
$79K |
| 90686 |
|
218 |
166 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
25 |
12 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
16 |
12 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
15 |
12 |
$1K |
| 0502F |
|
19 |
16 |
$837.90 |
| 90656 |
|
22 |
14 |
$303.20 |
| 86580 |
|
21 |
16 |
$89.40 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$0.00 |