| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
66 |
66 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
15 |
15 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
14 |
$1K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
64 |
64 |
$637.44 |
| 99173 |
|
15 |
15 |
$360.00 |
| 96127 |
|
49 |
48 |
$208.74 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$128.40 |