| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
131 |
125 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
78 |
57 |
$695.30 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
73 |
73 |
$660.65 |
| 90461 |
|
28 |
28 |
$452.64 |
| 96127 |
|
15 |
15 |
$195.13 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
61 |
53 |
$0.00 |
| 90686 |
|
31 |
31 |
$0.00 |
| 92551 |
|
14 |
14 |
$0.00 |