| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
143 |
134 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17 |
15 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
51 |
30 |
$1K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
76 |
76 |
$687.80 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
63 |
63 |
$647.01 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
21 |
21 |
$429.45 |
| 90461 |
|
12 |
12 |
$403.44 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
17 |
16 |
$200.77 |