| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96127 |
|
1,037 |
1,037 |
$11K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
981 |
861 |
$10K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
1,025 |
1,020 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,327 |
1,265 |
$6K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
296 |
295 |
$3K |
| 90480 |
|
76 |
76 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
285 |
276 |
$746.44 |
| 92551 |
|
55 |
55 |
$489.28 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
659 |
635 |
$481.70 |
| 90677 |
|
43 |
43 |
$298.04 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
420 |
420 |
$166.30 |
| 90620 |
|
13 |
13 |
$96.30 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
788 |
787 |
$81.80 |
| 90686 |
|
275 |
275 |
$60.35 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
427 |
427 |
$39.36 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
305 |
295 |
$35.70 |
| 90656 |
|
111 |
111 |
$9.21 |
| 90651 |
|
112 |
112 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
448 |
448 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
457 |
457 |
$0.00 |
| 90633 |
|
24 |
24 |
$0.00 |
| 99173 |
|
29 |
29 |
$0.00 |
| 90670 |
|
51 |
51 |
$0.00 |