| 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) |
113 |
113 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
36 |
36 |
$369.72 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
152 |
149 |
$63.73 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
41 |
40 |
$0.00 |