| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
971 |
906 |
$46K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
387 |
387 |
$11K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
155 |
154 |
$10K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
156 |
155 |
$9K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
320 |
312 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
94 |
88 |
$7K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
251 |
251 |
$5K |
| 92553 |
|
303 |
303 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
68 |
68 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
26 |
26 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
26 |
26 |
$2K |
| 90461 |
|
114 |
114 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
88 |
87 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
64 |
64 |
$725.62 |
| 3008F |
|
916 |
839 |
$580.00 |
| 92587 |
|
36 |
35 |
$532.76 |
| 99173 |
|
116 |
116 |
$204.41 |
| 90686 |
|
15 |
15 |
$182.39 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
12 |
12 |
$150.04 |
| 96127 |
|
81 |
81 |
$113.88 |
| 99177 |
|
13 |
13 |
$30.31 |
| 99071 |
|
89 |
87 |
$0.00 |
| 99000 |
|
26 |
26 |
$0.00 |