| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
223 |
205 |
$15K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
153 |
153 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
29 |
29 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
17 |
17 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
13 |
13 |
$1K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
111 |
111 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
114 |
112 |
$996.31 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
59 |
58 |
$683.49 |
| 92583 |
|
12 |
12 |
$533.52 |
| 99173 |
|
61 |
61 |
$397.56 |
| 92551 |
|
25 |
25 |
$257.04 |
| 92567 |
|
14 |
13 |
$169.54 |
| 96127 |
|
30 |
30 |
$121.80 |