| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
111 |
104 |
$11K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
81 |
81 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
108 |
98 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
40 |
39 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
762 |
755 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
27 |
27 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
367 |
366 |
$741.10 |
| 90686 |
|
145 |
143 |
$180.36 |
| 90685 |
|
29 |
29 |
$125.19 |
| 90670 |
|
58 |
58 |
$0.00 |
| 90698 |
|
38 |
38 |
$0.00 |
| 90680 |
|
25 |
25 |
$0.00 |
| 90474 |
|
25 |
25 |
$0.00 |