| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,863 |
4,346 |
$357K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
405 |
366 |
$21K |
| X5622 |
|
63 |
57 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
630 |
547 |
$119.66 |
| 90688 |
|
124 |
120 |
$53.64 |
| 90686 |
|
181 |
150 |
$39.51 |
| 96127 |
|
63 |
58 |
$0.04 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
78 |
70 |
$0.00 |
| 92551 |
|
96 |
85 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
48 |
44 |
$0.00 |
| 99173 |
|
95 |
85 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
28 |
28 |
$0.00 |
| 99401 |
|
47 |
42 |
$0.00 |