| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
109 |
104 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
44 |
44 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
20 |
20 |
$793.87 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
41 |
41 |
$450.38 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
48 |
48 |
$416.46 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
31 |
31 |
$381.72 |
| 92551 |
|
17 |
17 |
$187.08 |