| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
60 |
58 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
24 |
24 |
$492.28 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
33 |
33 |
$246.60 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
19 |
19 |
$203.30 |
| 90686 |
|
12 |
12 |
$0.00 |