| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
11,066 |
10,374 |
$327K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,176 |
6,825 |
$266K |
| X5622 |
|
3,484 |
3,266 |
$246K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,730 |
3,646 |
$187K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,623 |
3,913 |
$170K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,072 |
1,991 |
$126K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,418 |
1,378 |
$67K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,085 |
3,020 |
$52K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,351 |
3,280 |
$42K |
| 99188 |
|
4,577 |
4,485 |
$29K |
| 92551 |
|
4,120 |
4,047 |
$28K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
796 |
761 |
$27K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
142 |
142 |
$9K |
| 99173 |
|
3,908 |
3,844 |
$9K |
| 90461 |
|
354 |
338 |
$6K |
| S0281 |
Medical home program, comprehensive care coordination and planning, maintenance of plan |
240 |
238 |
$4K |
| 99460 |
|
81 |
78 |
$4K |
| 90473 |
|
319 |
314 |
$4K |
| 69210 |
|
138 |
136 |
$3K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
66 |
65 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
78 |
77 |
$2K |
| 99215 |
Prolong outpt/office vis |
13 |
12 |
$1K |
| 90670 |
|
997 |
983 |
$1K |
| 90686 |
|
864 |
850 |
$1K |
| 96127 |
|
180 |
176 |
$745.65 |
| 90677 |
|
95 |
91 |
$508.26 |
| 96161 |
|
289 |
282 |
$325.41 |
| 90656 |
|
98 |
91 |
$315.01 |
| 90723 |
|
82 |
76 |
$261.34 |
| 90648 |
|
81 |
76 |
$232.76 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
18 |
15 |
$154.99 |
| 90633 |
|
104 |
101 |
$128.36 |
| 90651 |
|
12 |
12 |
$45.00 |
| 36416 |
|
13 |
13 |
$39.94 |
| 90680 |
|
256 |
255 |
$30.12 |
| 90710 |
|
13 |
13 |
$30.00 |
| 85018 |
|
13 |
13 |
$19.41 |
| 90698 |
|
504 |
501 |
$3.59 |
| 90685 |
|
41 |
41 |
$0.00 |
| 90744 |
|
87 |
87 |
$0.00 |