| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
842 |
549 |
$51K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
823 |
598 |
$45K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
644 |
447 |
$28K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
836 |
410 |
$15K |
| 96161 |
|
555 |
355 |
$6K |
| 99381 |
|
55 |
39 |
$4K |
| 92558 |
|
192 |
131 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
423 |
228 |
$2K |
| 96127 |
|
344 |
183 |
$2K |
| 99464 |
|
30 |
27 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
33 |
15 |
$1K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
19 |
12 |
$528.84 |
| 99462 |
|
34 |
15 |
$353.99 |
| 96160 |
|
19 |
12 |
$164.16 |
| 36416 |
|
27 |
13 |
$20.82 |
| 90671 |
|
322 |
190 |
$0.01 |
| 90686 |
|
233 |
122 |
$0.01 |
| 90461 |
|
241 |
106 |
$0.00 |
| 90681 |
|
76 |
42 |
$0.00 |
| 99188 |
|
29 |
12 |
$0.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
13 |
$0.00 |
| 90670 |
|
18 |
12 |
$0.00 |
| 90697 |
|
207 |
143 |
$0.00 |
| 90656 |
|
62 |
58 |
$0.00 |
| 85018 |
|
309 |
141 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
33 |
13 |
$0.00 |