| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
266 |
227 |
$24K |
| 99215 |
Prolong outpt/office vis |
18 |
15 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
126 |
76 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
140 |
138 |
$1K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
121 |
119 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
15 |
15 |
$178.49 |
| 87070 |
|
14 |
14 |
$125.32 |
| 81005 |
|
26 |
26 |
$56.00 |
| 90686 |
|
45 |
45 |
$0.00 |