| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
108 |
108 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
42 |
42 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
33 |
33 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
63 |
63 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
15 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
102 |
101 |
$986.17 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
115 |
115 |
$847.26 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
15 |
$661.38 |
| 83655 |
|
29 |
29 |
$361.46 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$211.40 |
| 85018 |
|
31 |
31 |
$77.31 |
| 90648 |
|
12 |
12 |
$0.00 |