| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
93 |
84 |
$7K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
90 |
86 |
$4K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
15 |
14 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
125 |
118 |
$513.50 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
24 |
24 |
$228.96 |
| 83655 |
|
12 |
12 |
$128.16 |
| 99177 |
|
12 |
12 |
$44.16 |
| 85018 |
|
12 |
12 |
$25.08 |
| 90661 |
|
17 |
17 |
$0.00 |
| 90461 |
|
14 |
14 |
$0.00 |