| 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) |
248 |
248 |
$2K |
| 96127 |
|
115 |
115 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
71 |
70 |
$923.62 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
262 |
158 |
$640.98 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
12 |
12 |
$130.60 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
36 |
36 |
$96.15 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
14 |
$0.00 |
| 90661 |
|
12 |
12 |
$0.00 |