| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
73 |
69 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
55 |
47 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
39 |
29 |
$3K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
17 |
17 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
18 |
17 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
14 |
$1K |
| 90661 |
|
37 |
24 |
$621.27 |
| D1206 |
Topical application of fluoride varnish |
14 |
12 |
$382.20 |
| 90677 |
|
15 |
12 |
$250.65 |