| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
112 |
106 |
$6K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
24 |
24 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$916.80 |
| 90686 |
|
44 |
44 |
$477.74 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
157 |
157 |
$399.22 |
| 90461 |
|
83 |
83 |
$123.28 |
| 90670 |
|
12 |
12 |
$121.00 |
| 99173 |
|
45 |
45 |
$113.96 |