| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
457 |
451 |
$28K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
124 |
119 |
$11K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
356 |
160 |
$8K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
89 |
89 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
46 |
46 |
$4K |
| 99173 |
|
167 |
167 |
$4K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
414 |
414 |
$4K |
| 96127 |
|
256 |
254 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
20 |
20 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
116 |
113 |
$1K |
| 0071A |
|
19 |
19 |
$871.72 |
| 99051 |
|
49 |
49 |
$850.74 |
| 99177 |
|
57 |
57 |
$633.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
28 |
28 |
$572.60 |
| 92552 |
|
15 |
15 |
$388.80 |
| 92587 |
|
15 |
15 |
$253.35 |
| 92558 |
|
16 |
16 |
$122.40 |
| 90686 |
|
13 |
13 |
$0.00 |