| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
221 |
196 |
$13K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
36 |
36 |
$851.23 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
28 |
28 |
$250.90 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
17 |
17 |
$172.76 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
13 |
13 |
$0.00 |