| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,969 |
2,309 |
$460K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,340 |
1,067 |
$209K |
| X5622 |
|
58 |
27 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
12 |
$34.46 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
326 |
197 |
$21.01 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
107 |
54 |
$0.10 |
| 99173 |
|
103 |
54 |
$0.09 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
69 |
57 |
$0.00 |
| 92552 |
|
113 |
54 |
$0.00 |
| 90686 |
|
88 |
67 |
$0.00 |