| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
241 |
234 |
$8K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,525 |
1,471 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
957 |
883 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,097 |
1,012 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
299 |
289 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
217 |
216 |
$629.63 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
160 |
157 |
$589.02 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
25 |
25 |
$441.72 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$229.64 |
| 90707 |
|
164 |
162 |
$228.57 |
| 90688 |
|
261 |
257 |
$183.72 |
| 92552 |
|
237 |
228 |
$75.00 |
| 90656 |
|
63 |
62 |
$44.40 |
| 90461 |
|
152 |
148 |
$35.86 |
| 99173 |
|
649 |
627 |
$28.16 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
72 |
69 |
$27.76 |
| 90686 |
|
624 |
603 |
$19.58 |
| 96127 |
|
69 |
67 |
$4.80 |
| 90716 |
|
12 |
12 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
163 |
158 |
$0.00 |
| 3008F |
|
113 |
108 |
$0.00 |
| S9999 |
Sales tax |
632 |
599 |
$0.00 |
| 99072 |
|
101 |
97 |
$0.00 |
| 90685 |
|
15 |
15 |
$0.00 |