| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
279 |
270 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
206 |
200 |
$8K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
797 |
792 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
344 |
338 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
53 |
53 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
40 |
40 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$652.80 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
189 |
188 |
$388.55 |
| 96127 |
|
104 |
103 |
$61.62 |
| 90461 |
|
60 |
60 |
$19.68 |
| 92551 |
|
13 |
13 |
$0.00 |
| 99173 |
|
12 |
12 |
$0.00 |