| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
264 |
263 |
$2K |
| 92552 |
|
201 |
201 |
$2K |
| G9920 |
Screening performed and negative |
69 |
69 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$537.60 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$529.48 |
| 99173 |
|
153 |
153 |
$388.36 |
| 81003 |
|
111 |
110 |
$239.94 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
26 |
15 |
$202.00 |
| 83026 |
|
57 |
57 |
$148.50 |
| 81000 |
|
33 |
33 |
$82.56 |
| 90656 |
|
43 |
43 |
$0.00 |
| 81002 |
|
15 |
15 |
$0.00 |