| 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) |
301 |
299 |
$12K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,476 |
1,455 |
$11K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
444 |
435 |
$2K |
| 90461 |
|
363 |
355 |
$848.34 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,095 |
2,766 |
$435.72 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
722 |
706 |
$321.78 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
446 |
444 |
$120.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
590 |
582 |
$0.00 |
| 86580 |
|
30 |
29 |
$0.00 |
| 96127 |
|
123 |
121 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
144 |
143 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
156 |
154 |
$0.00 |
| S9999 |
Sales tax |
19 |
12 |
$0.00 |
| 99173 |
|
2,079 |
2,045 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
13 |
$0.00 |
| 99072 |
|
84 |
83 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
68 |
32 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
41 |
36 |
$0.00 |