| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,037 |
7,712 |
$471K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,383 |
1,239 |
$97K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
367 |
342 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
128 |
121 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
45 |
44 |
$1K |
| 96127 |
|
222 |
198 |
$742.50 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
20 |
13 |
$458.50 |
| 92551 |
|
53 |
51 |
$292.10 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
13 |
12 |
$77.36 |
| 99173 |
|
54 |
41 |
$48.24 |
| 99188 |
|
15 |
13 |
$14.28 |
| X5622 |
|
156 |
154 |
$0.00 |