| 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) |
585 |
567 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,595 |
2,360 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
843 |
781 |
$5K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
697 |
677 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
72 |
67 |
$902.20 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
68 |
66 |
$569.00 |
| S9999 |
Sales tax |
4,328 |
3,944 |
$484.59 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
229 |
218 |
$409.92 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
53 |
52 |
$352.23 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
39 |
38 |
$246.28 |
| 92551 |
|
462 |
454 |
$125.86 |
| 99173 |
|
470 |
462 |
$29.61 |
| 90461 |
|
132 |
129 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
24 |
12 |
$0.00 |
| 96127 |
|
25 |
25 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
147 |
143 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
32 |
32 |
$0.00 |