| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
95 |
87 |
$15K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
26 |
26 |
$1K |
| 99188 |
|
32 |
32 |
$836.00 |
| 90461 |
|
16 |
16 |
$522.48 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
47 |
47 |
$459.25 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
47 |
47 |
$427.17 |
| 92551 |
|
12 |
12 |
$113.50 |