| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,644 |
2,499 |
$129K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,151 |
3,117 |
$56K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,744 |
3,130 |
$39K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
428 |
428 |
$29K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
521 |
520 |
$28K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
843 |
800 |
$26K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
2,486 |
2,475 |
$24K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
374 |
372 |
$23K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
559 |
535 |
$22K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,073 |
514 |
$15K |
| 90461 |
|
569 |
566 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
134 |
133 |
$7K |
| 92552 |
|
185 |
185 |
$5K |
| 99173 |
|
233 |
233 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
317 |
314 |
$4K |
| 90480 |
|
69 |
69 |
$3K |
| 96127 |
|
195 |
195 |
$2K |
| 0071A |
|
40 |
40 |
$2K |
| 87807 |
|
151 |
139 |
$2K |
| 0052A |
|
37 |
37 |
$2K |
| 0072A |
|
38 |
38 |
$2K |
| 99441 |
|
156 |
151 |
$1K |
| 0074A |
|
26 |
26 |
$1K |
| 0001A |
|
26 |
26 |
$1K |
| 87428 |
|
15 |
14 |
$953.85 |
| 0002A |
|
18 |
18 |
$825.66 |
| 0004A |
|
14 |
14 |
$642.19 |
| 85018 |
|
131 |
131 |
$280.02 |
| 90686 |
|
942 |
940 |
$0.00 |
| 91305 |
|
42 |
40 |
$0.00 |
| 90697 |
|
26 |
26 |
$0.00 |
| 91307 |
|
146 |
137 |
$0.00 |
| 90680 |
|
24 |
24 |
$0.00 |
| 96160 |
|
372 |
370 |
$0.00 |
| 90633 |
|
164 |
163 |
$0.00 |
| 90670 |
|
75 |
75 |
$0.00 |
| 91300 |
|
62 |
44 |
$0.00 |