| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
168 |
167 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
93 |
89 |
$8K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
151 |
71 |
$3K |
| 99173 |
|
55 |
55 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$1K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
128 |
128 |
$1K |
| 99051 |
|
45 |
45 |
$769.83 |
| 96127 |
|
42 |
42 |
$441.61 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$323.34 |
| 90686 |
|
14 |
14 |
$0.00 |