| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
569 |
532 |
$35K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
133 |
124 |
$12K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
126 |
126 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
500 |
477 |
$5K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
333 |
333 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
12 |
12 |
$957.72 |
| 87428 |
|
15 |
14 |
$937.50 |
| 90461 |
|
16 |
16 |
$485.27 |
| 90686 |
|
15 |
15 |
$0.00 |