| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
756 |
711 |
$4K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
427 |
427 |
$3K |
| 96127 |
|
135 |
130 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
50 |
50 |
$760.59 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
14 |
13 |
$402.35 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
326 |
180 |
$265.85 |
| 90656 |
|
13 |
12 |
$0.00 |
| 90661 |
|
44 |
44 |
$0.00 |