| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
88 |
88 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
140 |
130 |
$10K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
47 |
47 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
66 |
66 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
27 |
27 |
$1K |
| 96127 |
|
112 |
111 |
$792.00 |