| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90715 |
|
48 |
48 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,651 |
1,586 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,059 |
1,007 |
$876.15 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
448 |
448 |
$837.72 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
398 |
398 |
$495.00 |
| 90686 |
|
19 |
19 |
$399.00 |
| 90656 |
|
17 |
17 |
$213.18 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
136 |
136 |
$0.00 |