| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
147 |
141 |
$8K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
77 |
77 |
$3K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
160 |
160 |
$1K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
28 |
28 |
$1K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
12 |
12 |
$323.26 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
30 |
30 |
$308.10 |
| 96127 |
|
17 |
17 |
$174.59 |