| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96127 |
|
26 |
25 |
$267.02 |
| 90658 |
|
16 |
16 |
$181.92 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
12 |
12 |
$108.60 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
66 |
64 |
$35.70 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
44 |
42 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
90 |
88 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
17 |
17 |
$0.00 |