| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
203 |
193 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,947 |
1,763 |
$5K |
| 90688 |
|
40 |
39 |
$606.56 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
184 |
181 |
$497.82 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
423 |
414 |
$362.67 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
80 |
79 |
$275.74 |
| 97802 |
|
13 |
13 |
$136.24 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
154 |
148 |
$30.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
941 |
920 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
196 |
194 |
$0.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
1,032 |
1,003 |
$0.00 |
| G9459 |
Currently a tobacco non-user |
276 |
269 |
$0.00 |
| G9275 |
Documentation that patient is a current non-tobacco user |
39 |
39 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
179 |
177 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
127 |
117 |
$0.00 |
| 3725F |
|
188 |
185 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
32 |
31 |
$0.00 |
| S9999 |
Sales tax |
30 |
25 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
13 |
$0.00 |