| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,770 |
1,580 |
$97K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
618 |
593 |
$26K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
206 |
187 |
$6K |
| 96127 |
|
741 |
681 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
224 |
203 |
$2K |
| 92551 |
|
175 |
163 |
$1K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
12 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
12 |
$833.33 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
74 |
70 |
$616.08 |
| 90686 |
|
289 |
268 |
$480.89 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
12 |
12 |
$275.10 |
| 99173 |
|
174 |
162 |
$256.71 |
| 90461 |
|
12 |
12 |
$246.67 |
| X5622 |
|
121 |
117 |
$0.00 |
| 90672 |
|
12 |
12 |
$0.00 |