| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
28 |
28 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
22 |
22 |
$3K |
| 90686 |
|
50 |
50 |
$1K |
| 90670 |
|
24 |
24 |
$484.80 |
| 90723 |
|
24 |
24 |
$484.80 |
| 90680 |
|
23 |
23 |
$464.60 |
| 90647 |
|
15 |
15 |
$303.00 |
| 96161 |
|
24 |
24 |
$83.52 |
| 99173 |
|
20 |
20 |
$61.80 |
| 99177 |
|
13 |
13 |
$60.32 |
| 99051 |
|
51 |
51 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
72 |
71 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
39 |
38 |
$0.00 |