| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
165 |
161 |
$11K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
48 |
48 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
81 |
81 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$1K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
101 |
100 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
26 |
26 |
$278.20 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
24 |
12 |
$233.88 |
| 96127 |
|
53 |
53 |
$225.78 |