| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
579 |
495 |
$32K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
226 |
191 |
$18K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
59 |
56 |
$6K |
| D1206 |
Topical application of fluoride varnish |
196 |
178 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
49 |
47 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
317 |
308 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
19 |
19 |
$2K |
| 90686 |
|
89 |
82 |
$2K |
| 92551 |
|
185 |
181 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
17 |
16 |
$1K |
| 96127 |
|
199 |
184 |
$805.42 |
| 99173 |
|
170 |
165 |
$398.84 |
| 99177 |
|
73 |
69 |
$392.40 |
| 95012 |
|
32 |
29 |
$385.75 |
| 81000 |
|
147 |
142 |
$349.76 |
| 2015F |
|
88 |
80 |
$320.00 |
| 96160 |
|
96 |
87 |
$285.24 |
| 90670 |
|
15 |
14 |
$209.52 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
12 |
12 |
$208.08 |
| 99188 |
|
28 |
25 |
$90.00 |
| 36415 |
Collection of venous blood by venipuncture |
19 |
15 |
$53.90 |
| 81002 |
|
32 |
28 |
$41.83 |
| 99000 |
|
25 |
22 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
16 |
14 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
15 |
15 |
$0.00 |