| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
20 |
20 |
$703.38 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$390.69 |
| 92551 |
|
35 |
34 |
$282.80 |
| 90713 |
|
14 |
14 |
$30.21 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
49 |
48 |
$0.00 |
| 92081 |
|
15 |
15 |
$0.00 |
| 90700 |
|
29 |
29 |
$0.00 |
| 90670 |
|
13 |
13 |
$0.00 |
| 90648 |
|
13 |
13 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
80 |
78 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
38 |
36 |
$0.00 |