| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,168 |
2,087 |
$18K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
824 |
822 |
$6K |
| 96127 |
|
183 |
180 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
725 |
400 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
168 |
153 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
165 |
159 |
$978.41 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
12 |
12 |
$333.25 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
98 |
98 |
$273.73 |
| 90480 |
|
12 |
12 |
$176.60 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$158.19 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$82.86 |
| 99173 |
|
25 |
25 |
$23.17 |
| 90686 |
|
12 |
12 |
$0.00 |
| 90656 |
|
18 |
18 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
25 |
25 |
$0.00 |
| 90661 |
|
115 |
114 |
$0.00 |
| 99072 |
|
12 |
12 |
$0.00 |