| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
505 |
425 |
$26K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
289 |
269 |
$7K |
| 92567 |
|
346 |
321 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
29 |
27 |
$961.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$791.46 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$785.31 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$780.40 |
| 92587 |
|
39 |
39 |
$707.54 |
| 86580 |
|
55 |
54 |
$331.84 |
| 81001 |
|
25 |
25 |
$66.68 |
| 99173 |
|
28 |
28 |
$40.86 |
| 90686 |
|
12 |
12 |
$0.00 |
| 90700 |
|
12 |
12 |
$0.00 |