| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,683 |
5,151 |
$42K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
515 |
482 |
$18K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,212 |
1,051 |
$11K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,124 |
1,063 |
$11K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,193 |
3,921 |
$9K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
656 |
621 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
422 |
400 |
$5K |
| 90461 |
|
1,458 |
1,379 |
$1K |
| 99072 |
|
155 |
136 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
13 |
$260.68 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
68 |
68 |
$152.16 |
| 86580 |
|
70 |
65 |
$104.06 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
208 |
192 |
$0.00 |
| 90688 |
|
1,636 |
1,575 |
$0.00 |
| 90698 |
|
556 |
510 |
$0.00 |
| 96127 |
|
12 |
12 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
371 |
343 |
$0.00 |
| 90656 |
|
149 |
145 |
$0.00 |
| 90744 |
|
107 |
98 |
$0.00 |
| 90680 |
|
174 |
166 |
$0.00 |
| 90651 |
|
113 |
108 |
$0.00 |
| 90686 |
|
30 |
27 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
445 |
424 |
$0.00 |
| G8418 |
Bmi is documented below normal parameters and a follow-up plan is documented |
51 |
49 |
$0.00 |
| 90670 |
|
727 |
682 |
$0.00 |
| S9999 |
Sales tax |
760 |
656 |
$0.00 |
| 90633 |
|
113 |
110 |
$0.00 |
| 90700 |
|
42 |
40 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
65 |
63 |
$0.00 |
| 90734 |
|
63 |
58 |
$0.00 |
| 90687 |
|
58 |
57 |
$0.00 |
| 90710 |
|
16 |
16 |
$0.00 |