| 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) |
241 |
240 |
$2K |
| 96127 |
|
124 |
123 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
131 |
128 |
$594.74 |
| 81002 |
|
132 |
131 |
$396.03 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
342 |
183 |
$377.20 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
32 |
30 |
$328.64 |
| 90686 |
|
14 |
14 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$0.00 |
| 99173 |
|
20 |
20 |
$0.00 |