| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
25 |
25 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
14 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
16 |
16 |
$476.76 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
14 |
14 |
$149.80 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
14 |
14 |
$75.60 |