| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
101 |
95 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
28 |
28 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
16 |
16 |
$515.02 |
| 99051 |
|
24 |
24 |
$437.28 |
| 99050 |
|
18 |
15 |
$273.76 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
20 |
20 |
$205.00 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
21 |
21 |
$178.52 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$148.63 |