| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
151 |
133 |
$11K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
415 |
166 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
31 |
31 |
$3K |
| 99381 |
|
17 |
17 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$996.36 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$951.36 |
| 90461 |
|
110 |
81 |
$629.88 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
32 |
28 |
$553.14 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16 |
16 |
$230.87 |
| 94760 |
|
16 |
16 |
$0.00 |