| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,504 |
1,400 |
$92K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
782 |
720 |
$58K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
41 |
41 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
109 |
109 |
$1K |
| 92551 |
|
103 |
103 |
$732.03 |
| 90686 |
|
107 |
107 |
$718.08 |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
203 |
203 |
$641.16 |
| 99173 |
|
103 |
103 |
$159.53 |
| 90656 |
|
15 |
15 |
$97.64 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
12 |
12 |
$94.74 |
| X5622 |
|
12 |
12 |
$0.00 |