| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
275 |
262 |
$13K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
318 |
266 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
61 |
56 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
19 |
17 |
$762.60 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
180 |
174 |
$566.39 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
32 |
31 |
$286.20 |
| 90686 |
|
97 |
91 |
$38.61 |