| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
19 |
14 |
$181.92 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
68 |
42 |
$81.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
109 |
57 |
$36.63 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
24 |
12 |
$0.00 |
| 90670 |
|
19 |
12 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
24 |
14 |
$0.00 |