| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
925 |
878 |
$8K |
| 96127 |
|
613 |
607 |
$7K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
574 |
574 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
443 |
375 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
21 |
21 |
$1K |
| 90480 |
|
20 |
20 |
$910.52 |
| 90686 |
|
160 |
160 |
$197.80 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
547 |
547 |
$143.15 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
406 |
392 |
$84.51 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
252 |
252 |
$78.72 |
| 90656 |
|
46 |
46 |
$9.21 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
86 |
86 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
170 |
170 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
27 |
27 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |