| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,272 |
5,731 |
$480K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
147 |
141 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
66 |
66 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
42 |
41 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
14 |
14 |
$14.90 |
| 90461 |
|
12 |
12 |
$7.45 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
26 |
26 |
$0.00 |
| 90723 |
|
16 |
16 |
$0.00 |