| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
106 |
104 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
75 |
75 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
47 |
47 |
$2K |
| 92551 |
|
105 |
105 |
$1K |
| 90686 |
|
33 |
33 |
$628.02 |
| 90670 |
|
52 |
52 |
$207.00 |
| 90633 |
|
13 |
13 |
$81.00 |
| 90685 |
|
13 |
13 |
$63.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
41 |
41 |
$47.52 |
| 90700 |
|
16 |
16 |
$45.00 |
| 90648 |
|
13 |
13 |
$36.00 |
| 90698 |
|
13 |
13 |
$36.00 |
| 90680 |
|
12 |
12 |
$36.00 |
| 99173 |
|
97 |
97 |
$0.00 |
| 90461 |
|
39 |
39 |
$0.00 |
| 99401 |
|
116 |
116 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
197 |
80 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
17 |
17 |
$0.00 |
| 97802 |
|
33 |
33 |
$0.00 |