| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,717 |
1,568 |
$11K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
1,333 |
1,326 |
$10K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
834 |
830 |
$9K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
531 |
523 |
$3K |
| 96127 |
|
170 |
169 |
$2K |
| 99188 |
|
53 |
53 |
$1K |
| 99381 |
|
12 |
12 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
31 |
28 |
$991.29 |
| 83655 |
|
67 |
67 |
$683.52 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,314 |
1,056 |
$437.35 |
| 99177 |
|
91 |
91 |
$331.68 |
| 85018 |
|
59 |
59 |
$123.31 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
231 |
231 |
$83.15 |
| 90686 |
|
71 |
71 |
$40.00 |
| 90697 |
|
104 |
103 |
$0.00 |
| 90680 |
|
90 |
90 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
16 |
16 |
$0.00 |
| 90677 |
|
194 |
190 |
$0.00 |
| 90656 |
|
44 |
44 |
$0.00 |
| 99072 |
|
243 |
173 |
$0.00 |
| 90661 |
|
179 |
170 |
$0.00 |