| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
527 |
523 |
$11K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
27 |
27 |
$469.04 |
| 0071A |
|
14 |
14 |
$380.38 |
| 0072A |
|
14 |
14 |
$377.16 |
| 0001A |
|
14 |
14 |
$350.99 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17 |
15 |
$270.49 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
40 |
40 |
$216.53 |
| 90633 |
|
26 |
26 |
$0.00 |
| 90734 |
|
25 |
24 |
$0.00 |
| 91300 |
|
26 |
26 |
$0.00 |
| 90686 |
|
188 |
186 |
$0.00 |
| 91307 |
|
36 |
36 |
$0.00 |