| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
271 |
166 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
687 |
590 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
652 |
594 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,210 |
768 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
26 |
25 |
$480.00 |
| 92552 |
|
112 |
100 |
$54.60 |
| 96160 |
|
270 |
164 |
$40.43 |
| 92551 |
|
126 |
80 |
$10.53 |
| 99173 |
|
218 |
156 |
$7.23 |
| 94760 |
|
134 |
119 |
$0.00 |
| 90656 |
|
44 |
40 |
$0.00 |
| 96127 |
|
16 |
15 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
19 |
19 |
$0.00 |