| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90670 |
|
16 |
16 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
99 |
74 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
62 |
58 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
18 |
18 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
19 |
19 |
$1K |
| 90698 |
|
15 |
15 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
18 |
18 |
$967.86 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$857.19 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$765.49 |
| 90686 |
|
28 |
28 |
$513.78 |
| 92551 |
|
17 |
17 |
$108.46 |
| 99173 |
|
34 |
34 |
$85.32 |
| 90461 |
|
78 |
45 |
$20.00 |