| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
557 |
520 |
$11K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
165 |
158 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
172 |
164 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
143 |
136 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
439 |
419 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
29 |
27 |
$1K |
| 99173 |
|
934 |
896 |
$188.56 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$120.00 |
| 90461 |
|
15 |
15 |
$55.12 |
| 90688 |
|
16 |
12 |
$38.34 |
| 90686 |
|
121 |
111 |
$24.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
354 |
333 |
$19.05 |
| 99072 |
|
16 |
13 |
$18.03 |
| 96127 |
|
82 |
76 |
$12.00 |
| S9999 |
Sales tax |
155 |
130 |
$0.11 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
81 |
75 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
91 |
85 |
$0.00 |
| 90651 |
|
18 |
13 |
$0.00 |