| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
13 |
$2K |
| 99188 |
|
50 |
50 |
$426.50 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
17 |
17 |
$0.00 |
| 90461 |
|
12 |
12 |
$0.00 |
| 92551 |
|
44 |
44 |
$0.00 |