| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
70 |
69 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
14 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
15 |
15 |
$512.80 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
18 |
18 |
$199.90 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
20 |
20 |
$164.73 |