| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
61 |
61 |
$694.56 |
| 92552 |
|
107 |
107 |
$575.70 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$271.40 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
341 |
301 |
$0.00 |
| 90656 |
|
28 |
28 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
87 |
87 |
$0.00 |
| 99173 |
|
79 |
79 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
27 |
27 |
$0.00 |