| 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) |
250 |
245 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,447 |
1,324 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
29 |
26 |
$214.48 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
28 |
26 |
$175.84 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
117 |
117 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
66 |
66 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
24 |
12 |
$0.00 |
| 99173 |
|
12 |
12 |
$0.00 |
| 96127 |
|
161 |
161 |
$0.00 |
| 92551 |
|
12 |
12 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
121 |
121 |
$0.00 |