| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
432 |
428 |
$3K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
276 |
273 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
132 |
131 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
172 |
154 |
$652.80 |
| Q0091 |
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory |
12 |
12 |
$287.64 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
14 |
14 |
$143.78 |
| 1123F |
|
12 |
12 |
$0.00 |
| 0502F |
|
103 |
87 |
$0.00 |