| 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) |
532 |
509 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,153 |
1,081 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
746 |
728 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
715 |
694 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
506 |
491 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
396 |
370 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
308 |
299 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
520 |
471 |
$3K |
| 97802 |
|
1,561 |
1,505 |
$878.82 |
| 87428 |
|
15 |
13 |
$708.69 |
| 90686 |
|
563 |
547 |
$42.05 |
| 90656 |
|
168 |
164 |
$19.77 |
| 99173 |
|
1,690 |
1,643 |
$11.06 |
| 92551 |
|
1,693 |
1,646 |
$10.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
841 |
823 |
$0.00 |
| S9451 |
Exercise classes, non-physician provider, per session |
1,782 |
1,730 |
$0.00 |
| 90696 |
|
13 |
12 |
$0.00 |
| G9459 |
Currently a tobacco non-user |
779 |
759 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
937 |
913 |
$0.00 |
| 90651 |
|
40 |
40 |
$0.00 |
| 90698 |
|
14 |
14 |
$0.00 |
| 90680 |
|
15 |
13 |
$0.00 |
| 90697 |
|
28 |
26 |
$0.00 |
| 90685 |
|
123 |
123 |
$0.00 |
| S9999 |
Sales tax |
164 |
132 |
$0.00 |
| 90670 |
|
214 |
201 |
$0.00 |
| 90633 |
|
37 |
36 |
$0.00 |
| 90710 |
|
15 |
14 |
$0.00 |
| 90734 |
|
15 |
14 |
$0.00 |