| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
108 |
102 |
$7K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
44 |
44 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
14 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
61 |
61 |
$580.64 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
40 |
23 |
$514.94 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
63 |
63 |
$444.84 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
30 |
30 |
$376.15 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15 |
15 |
$247.94 |
| 87081 |
|
24 |
24 |
$167.91 |
| 85018 |
|
15 |
15 |
$37.75 |
| 90686 |
|
14 |
14 |
$0.00 |