| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
446 |
440 |
$25K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
56 |
55 |
$6K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
21 |
21 |
$899.80 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
27 |
27 |
$552.15 |
| 90461 |
|
12 |
12 |
$482.16 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
41 |
41 |
$371.05 |
| 92558 |
|
28 |
28 |
$214.20 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
20 |
14 |
$174.62 |
| 96127 |
|
14 |
14 |
$143.78 |
| 99177 |
|
19 |
19 |
$70.68 |