| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
403 |
371 |
$23K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
229 |
126 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
49 |
46 |
$4K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
127 |
126 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
16 |
16 |
$164.32 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12 |
12 |
$146.76 |
| 96127 |
|
12 |
12 |
$123.24 |