| 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) |
604 |
597 |
$23K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,376 |
2,195 |
$17K |
| 99215 |
Prolong outpt/office vis |
1,503 |
1,379 |
$12K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
514 |
472 |
$12K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
759 |
749 |
$8K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
998 |
923 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,006 |
982 |
$6K |
| 87428 |
|
65 |
63 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,287 |
1,275 |
$3K |
| 99442 |
|
716 |
669 |
$2K |
| 99441 |
|
1,521 |
1,417 |
$2K |
| 99072 |
|
22 |
15 |
$360.60 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
107 |
107 |
$245.68 |
| 69210 |
|
195 |
192 |
$80.34 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
89 |
89 |
$78.36 |
| 90688 |
|
173 |
173 |
$75.36 |
| 96127 |
|
1,869 |
1,845 |
$72.38 |
| 99354 |
|
24 |
24 |
$66.64 |
| 90656 |
|
177 |
177 |
$22.20 |
| 90686 |
|
777 |
765 |
$19.58 |
| 94664 |
|
55 |
51 |
$16.57 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
157 |
157 |
$9.45 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
644 |
637 |
$7.35 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
66 |
60 |
$0.00 |
| 90621 |
|
32 |
31 |
$0.00 |
| G8431 |
Screening for depression is documented as being positive and a follow-up plan is documented |
12 |
12 |
$0.00 |
| 3078F |
|
57 |
57 |
$0.00 |
| 90707 |
|
42 |
42 |
$0.00 |
| 90734 |
|
14 |
13 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,519 |
1,497 |
$0.00 |
| 1036F |
|
287 |
281 |
$0.00 |
| 3008F |
|
153 |
152 |
$0.00 |
| 3074F |
|
103 |
103 |
$0.00 |