| Code | Description | Total Paid |
|---|---|---|
| 99349 | $3K | |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | $3K |
| 99443 | $1K | |
| 90715 | $195.04 | |
| 99442 | $115.79 | |
| 90686 | $114.48 | |
| 99441 | $82.99 | |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | $70.57 |
| 90461 | $52.22 | |
| 3074F | $2.12 |
| # | Provider | Location | Claims | Total Paid |
|---|---|---|---|---|
| 1 | SPENCER, TRUDY | BRONX, NY | 394 | $4K |
| 2 | COUNTY OF JEFFERSON | PORT TOWNSEND, WA | 533 | $3K |