| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
178 |
178 |
$2K |
| 96127 |
|
26 |
26 |
$267.02 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
24 |
24 |
$246.48 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
125 |
123 |
$102.25 |
| 90461 |
|
12 |
12 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
64 |
63 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
19 |
19 |
$0.00 |