| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,923 |
2,848 |
$643K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,572 |
1,239 |
$232K |
| X5622 |
|
113 |
112 |
$40K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
165 |
142 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
26 |
14 |
$256.66 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
133 |
122 |
$0.00 |
| 90686 |
|
97 |
97 |
$0.00 |
| 96127 |
|
50 |
28 |
$0.00 |
| 92551 |
|
26 |
15 |
$0.00 |
| 99173 |
|
47 |
27 |
$0.00 |