| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
173 |
168 |
$10K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
290 |
289 |
$9K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
395 |
395 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
323 |
323 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
40 |
40 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$1K |
| 99173 |
|
53 |
53 |
$1K |
| 92551 |
|
108 |
108 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$1K |