| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
873 |
741 |
$29K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
210 |
210 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
296 |
291 |
$4K |
| 90677 |
|
14 |
14 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
94 |
94 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
81 |
81 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
36 |
36 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
13 |
$670.26 |
| 92558 |
|
231 |
231 |
$585.52 |
| 96127 |
|
206 |
199 |
$522.58 |
| 90734 |
|
12 |
12 |
$472.05 |
| 90620 |
|
17 |
17 |
$447.50 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
41 |
40 |
$440.79 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$428.28 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
29 |
29 |
$337.12 |
| 90461 |
|
26 |
26 |
$267.75 |
| 83655 |
|
67 |
66 |
$262.83 |
| 3008F |
|
56 |
55 |
$90.00 |
| 90656 |
|
251 |
251 |
$31.34 |
| 99173 |
|
200 |
200 |
$15.47 |
| 90715 |
|
14 |
14 |
$0.00 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
226 |
225 |
$0.00 |
| 90686 |
|
13 |
13 |
$0.00 |
| 90651 |
|
17 |
17 |
$0.00 |