| 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) |
492 |
471 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,665 |
1,573 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,252 |
1,192 |
$12K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
294 |
282 |
$4K |
| 99072 |
|
232 |
206 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
204 |
185 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
120 |
114 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
220 |
212 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
46 |
41 |
$371.36 |
| 92551 |
|
473 |
461 |
$105.02 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
138 |
130 |
$6.71 |
| 96127 |
|
52 |
47 |
$3.92 |
| G9459 |
Currently a tobacco non-user |
64 |
59 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
29 |
26 |
$0.00 |