| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,919 |
4,724 |
$43K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,297 |
1,275 |
$27K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
84 |
83 |
$4K |
| 92551 |
|
1,574 |
1,528 |
$3K |
| G9920 |
Screening performed and negative |
114 |
114 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
67 |
64 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
174 |
166 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
475 |
470 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
136 |
128 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
102 |
102 |
$1K |
| 90658 |
|
394 |
394 |
$654.75 |
| D1206 |
Topical application of fluoride varnish |
166 |
153 |
$392.04 |
| 90648 |
|
115 |
109 |
$306.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
175 |
164 |
$289.85 |
| 90700 |
|
175 |
169 |
$225.00 |
| 90670 |
|
96 |
94 |
$144.00 |
| 90713 |
|
70 |
68 |
$90.00 |
| 85018 |
|
1,925 |
1,852 |
$86.34 |
| 90649 |
|
32 |
32 |
$36.00 |
| 81002 |
|
993 |
927 |
$24.88 |
| 86580 |
|
823 |
801 |
$17.05 |
| 99173 |
|
159 |
157 |
$10.04 |
| 90707 |
|
13 |
13 |
$9.00 |
| 90716 |
|
14 |
14 |
$9.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
245 |
242 |
$0.00 |
| 99177 |
|
55 |
55 |
$0.00 |
| 83655 |
|
13 |
13 |
$0.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
49 |
46 |
$0.00 |
| 94060 |
|
13 |
13 |
$0.00 |
| 94664 |
|
14 |
13 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
91 |
46 |
$0.00 |
| 90657 |
|
14 |
13 |
$0.00 |