| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
112 |
109 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
137 |
133 |
$10K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
18 |
18 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
104 |
104 |
$1K |
| 90461 |
|
32 |
32 |
$679.63 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
27 |
27 |
$199.80 |
| 97802 |
|
78 |
78 |
$0.00 |
| S9451 |
Exercise classes, non-physician provider, per session |
104 |
104 |
$0.00 |
| 90686 |
|
38 |
38 |
$0.00 |