| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
660 |
513 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,676 |
1,529 |
$3K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
231 |
196 |
$425.44 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
68 |
61 |
$346.84 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
14 |
14 |
$237.40 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
38 |
37 |
$75.19 |
| 96127 |
|
140 |
115 |
$52.84 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
568 |
485 |
$17.80 |
| 92551 |
|
96 |
93 |
$12.12 |
| 90686 |
|
43 |
36 |
$8.91 |
| 90698 |
|
12 |
12 |
$0.00 |
| 99173 |
|
207 |
185 |
$0.00 |
| G9920 |
Screening performed and negative |
159 |
159 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
46 |
46 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
66 |
63 |
$0.00 |
| 90670 |
|
24 |
24 |
$0.00 |
| 92552 |
|
31 |
31 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
19 |
18 |
$0.00 |