| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,795 |
3,837 |
$773K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,083 |
1,481 |
$334K |
| X5622 |
|
94 |
87 |
$30K |
| 98929 |
|
566 |
244 |
$8K |
| 99244 |
Office or other outpatient consultation, moderate to high complexity |
25 |
12 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
24 |
12 |
$2K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
108 |
87 |
$120.00 |
| 90686 |
|
103 |
102 |
$18.65 |
| 90656 |
|
18 |
12 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
100 |
92 |
$0.00 |
| 96127 |
|
86 |
53 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
42 |
32 |
$0.00 |
| 92551 |
|
23 |
14 |
$0.00 |
| 90461 |
|
13 |
13 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
93 |
80 |
$0.00 |
| 99173 |
|
45 |
26 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$0.00 |