| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
150 |
76 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
18 |
18 |
$383.50 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$372.78 |
| 92552 |
|
31 |
31 |
$171.15 |
| 85018 |
|
13 |
13 |
$38.48 |
| 99173 |
|
17 |
17 |
$27.30 |
| 90648 |
|
13 |
13 |
$0.00 |
| 90700 |
|
14 |
14 |
$0.00 |
| 90461 |
|
20 |
19 |
$0.00 |
| 90670 |
|
13 |
13 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,395 |
3,103 |
$0.00 |
| 96156 |
|
18 |
18 |
$0.00 |
| 90686 |
|
13 |
13 |
$0.00 |