| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,596 |
1,534 |
$90K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
675 |
655 |
$63K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,304 |
1,068 |
$47K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
1,572 |
1,563 |
$14K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
108 |
103 |
$9K |
| 90461 |
|
184 |
184 |
$7K |
| 96127 |
|
642 |
638 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
65 |
65 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
477 |
470 |
$5K |
| 99177 |
|
155 |
155 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
57 |
57 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
29 |
29 |
$3K |
| 92551 |
|
157 |
157 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
80 |
39 |
$978.40 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
28 |
27 |
$336.68 |
| 36416 |
|
14 |
14 |
$147.00 |
| 85018 |
|
28 |
28 |
$60.48 |