| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,656 |
3,783 |
$302K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
415 |
366 |
$36K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
961 |
949 |
$28K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,611 |
1,610 |
$16K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
98 |
98 |
$8K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
572 |
528 |
$7K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
193 |
179 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
55 |
53 |
$5K |
| 99173 |
|
108 |
107 |
$2K |
| 87428 |
|
26 |
25 |
$2K |
| 90461 |
|
47 |
47 |
$1K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
129 |
128 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
13 |
13 |
$1K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
12 |
12 |
$1K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
118 |
57 |
$1K |
| 96127 |
|
164 |
164 |
$634.68 |
| 87807 |
|
12 |
12 |
$140.40 |
| 81003 |
|
24 |
24 |
$0.00 |
| 94760 |
|
77 |
58 |
$0.00 |