| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,565 |
3,202 |
$47K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
550 |
515 |
$19K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
937 |
845 |
$16K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
947 |
908 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,097 |
1,028 |
$11K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
694 |
678 |
$8K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,962 |
2,759 |
$6K |
| 99072 |
|
343 |
314 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
332 |
318 |
$3K |
| 90461 |
|
1,092 |
1,046 |
$859.74 |
| 92551 |
|
1,300 |
1,244 |
$117.31 |
| 81002 |
|
370 |
354 |
$92.68 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
29 |
26 |
$60.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
363 |
348 |
$50.74 |
| 99173 |
|
1,311 |
1,255 |
$33.34 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
13 |
13 |
$22.85 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
39 |
39 |
$10.19 |
| 96127 |
|
265 |
256 |
$8.47 |
| S9999 |
Sales tax |
1,250 |
1,200 |
$0.02 |
| 99408 |
|
43 |
41 |
$0.00 |
| 90670 |
|
212 |
208 |
$0.00 |
| 90710 |
|
14 |
13 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| 90686 |
|
709 |
687 |
$0.00 |
| 3008F |
|
1,830 |
1,735 |
$0.00 |
| 90656 |
|
70 |
70 |
$0.00 |
| 90698 |
|
52 |
49 |
$0.00 |
| 90680 |
|
85 |
83 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
623 |
596 |
$0.00 |
| 90651 |
|
15 |
15 |
$0.00 |
| 90677 |
|
39 |
37 |
$0.00 |
| 90697 |
|
13 |
13 |
$0.00 |