| 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) |
786 |
786 |
$7K |
| 96127 |
|
555 |
555 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
543 |
464 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
636 |
615 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
134 |
134 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
454 |
448 |
$2K |
| 90461 |
|
196 |
195 |
$767.52 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
217 |
215 |
$582.05 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
174 |
167 |
$338.04 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
234 |
233 |
$331.44 |
| 85018 |
|
28 |
28 |
$58.52 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
82 |
82 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
21 |
21 |
$0.00 |