| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,654 |
2,998 |
$177K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,475 |
1,810 |
$102K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
28 |
27 |
$2K |
| 90686 |
|
129 |
126 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
135 |
130 |
$2K |
| 99497 |
|
41 |
41 |
$730.06 |
| 90674 |
|
16 |
16 |
$350.76 |
| 90658 |
|
16 |
16 |
$331.36 |
| 90688 |
|
28 |
27 |
$190.18 |
| 96127 |
|
26 |
24 |
$120.50 |
| G0008 |
Administration of influenza virus vaccine |
80 |
79 |
$75.94 |
| Q2035 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) |
36 |
33 |
$53.20 |
| Q2037 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin) |
44 |
44 |
$44.70 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
16 |
16 |
$0.00 |
| 3075F |
|
12 |
12 |
$0.00 |
| 1160F |
|
15 |
15 |
$0.00 |
| 3078F |
|
13 |
13 |
$0.00 |
| 1159F |
|
15 |
15 |
$0.00 |