| 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) |
105 |
92 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
201 |
199 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
12 |
$585.00 |
| 92551 |
|
284 |
270 |
$55.80 |
| 99173 |
|
292 |
278 |
$12.60 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
76 |
65 |
$11.63 |
| 96127 |
|
70 |
65 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
91 |
86 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
12 |
12 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
24 |
24 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$0.00 |