| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
224 |
197 |
$16K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
40 |
40 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
17 |
17 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
63 |
63 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
93 |
91 |
$1K |
| 92587 |
|
29 |
28 |
$946.66 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
84 |
81 |
$854.04 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
37 |
37 |
$649.60 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
47 |
47 |
$638.26 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
32 |
30 |
$434.56 |