| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
780 |
761 |
$45K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
451 |
300 |
$15K |
| 92558 |
|
242 |
241 |
$11K |
| 99177 |
|
237 |
237 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
76 |
76 |
$6K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
444 |
444 |
$4K |
| 90461 |
|
115 |
115 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
41 |
41 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
296 |
225 |
$3K |
| 99051 |
|
180 |
178 |
$3K |
| 96127 |
|
166 |
165 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
36 |
35 |
$736.20 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
39 |
39 |
$460.59 |