| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
290 |
277 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
528 |
526 |
$9K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
395 |
394 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,162 |
1,119 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
71 |
57 |
$9K |
| 92552 |
|
1,468 |
1,464 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
260 |
259 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
830 |
822 |
$1K |
| 90670 |
|
189 |
189 |
$1K |
| 90698 |
|
165 |
165 |
$1K |
| 90680 |
|
122 |
122 |
$1K |
| 99173 |
|
1,371 |
1,369 |
$840.64 |
| 90658 |
|
85 |
85 |
$315.00 |
| 90686 |
|
152 |
152 |
$234.00 |
| 90656 |
|
93 |
93 |
$90.00 |
| 90633 |
|
12 |
12 |
$72.00 |
| 90657 |
|
233 |
233 |
$72.00 |
| 90716 |
|
37 |
37 |
$54.00 |
| 90649 |
|
15 |
15 |
$18.00 |
| 90461 |
|
586 |
347 |
$16.16 |
| 90707 |
|
13 |
12 |
$9.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
20 |
17 |
$0.00 |