| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,300 |
5,050 |
$172K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,411 |
3,274 |
$160K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
154 |
154 |
$15K |
| 51798 |
|
1,512 |
1,429 |
$9K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
397 |
397 |
$4K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
415 |
415 |
$4K |
| 81000 |
|
1,249 |
1,197 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
53 |
53 |
$2K |
| 76775 |
|
12 |
12 |
$179.86 |
| 81003 |
|
29 |
27 |
$1.98 |
| 90686 |
|
58 |
58 |
$0.00 |
| 1090F |
|
49 |
38 |
$0.00 |