| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,325 |
2,834 |
$534K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,272 |
1,647 |
$383K |
| X5622 |
|
151 |
140 |
$46K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
188 |
144 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
179 |
163 |
$21.75 |
| 92551 |
|
105 |
75 |
$0.00 |
| 96127 |
|
125 |
80 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
94 |
78 |
$0.00 |
| 90686 |
|
82 |
68 |
$0.00 |
| 99173 |
|
67 |
37 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
63 |
60 |
$0.00 |