| 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) |
591 |
588 |
$4K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
16 |
15 |
$2K |
| 96127 |
|
222 |
220 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
244 |
238 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
39 |
39 |
$400.53 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
26 |
26 |
$390.80 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
766 |
425 |
$235.70 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
53 |
52 |
$180.66 |
| 90686 |
|
15 |
15 |
$20.00 |
| 90661 |
|
55 |
53 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$0.00 |