| 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) |
203 |
194 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,139 |
968 |
$1K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
934 |
732 |
$582.76 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
26 |
26 |
$240.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
43 |
42 |
$240.00 |
| 90688 |
|
138 |
135 |
$192.40 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
271 |
255 |
$120.00 |
| 90686 |
|
69 |
65 |
$97.90 |
| 90480 |
|
20 |
20 |
$69.33 |
| 92551 |
|
149 |
146 |
$20.26 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
60 |
58 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$0.00 |
| 90656 |
|
21 |
20 |
$0.00 |
| 99072 |
|
1,337 |
1,168 |
$0.00 |
| 91321 |
|
15 |
15 |
$0.00 |