| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
968 |
934 |
$57K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
423 |
421 |
$16K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
632 |
630 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
352 |
352 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
27 |
27 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
30 |
30 |
$2K |
| 99173 |
|
83 |
83 |
$2K |
| 81002 |
|
150 |
150 |
$425.59 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
19 |
19 |
$253.16 |
| 96127 |
|
35 |
35 |
$0.00 |