| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
373 |
369 |
$21K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
238 |
162 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
51 |
51 |
$4K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
285 |
285 |
$3K |
| 96127 |
|
178 |
178 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
48 |
48 |
$566.88 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
42 |
42 |
$431.34 |
| 87081 |
|
25 |
25 |
$171.00 |