| 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) |
193 |
191 |
$7K |
| 99421 |
|
435 |
427 |
$46.78 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
60 |
52 |
$36.31 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
29 |
29 |
$30.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
64 |
57 |
$12.56 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
38 |
38 |
$0.40 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
90 |
90 |
$0.00 |