| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,595 |
1,522 |
$136K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,605 |
1,539 |
$131K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,185 |
1,112 |
$106K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,247 |
1,143 |
$96K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
6,796 |
2,717 |
$75K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,329 |
4,486 |
$34K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,011 |
1,468 |
$17K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,170 |
2,059 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
449 |
426 |
$9K |
| 90461 |
|
1,780 |
1,436 |
$6K |
| 99429 |
|
165 |
149 |
$5K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
232 |
219 |
$425.06 |
| 90651 |
|
72 |
71 |
$276.48 |
| 90686 |
|
763 |
712 |
$60.45 |
| 90671 |
|
331 |
307 |
$0.03 |
| 90670 |
|
597 |
551 |
$0.00 |
| 90633 |
|
143 |
133 |
$0.00 |
| 90648 |
|
188 |
183 |
$0.00 |
| 90700 |
|
115 |
104 |
$0.00 |
| 90707 |
|
110 |
98 |
$0.00 |
| 90734 |
|
54 |
54 |
$0.00 |
| 90713 |
|
16 |
14 |
$0.00 |
| 90681 |
|
13 |
13 |
$0.00 |
| 90723 |
|
76 |
73 |
$0.00 |
| 90697 |
|
516 |
471 |
$0.00 |
| 90680 |
|
430 |
406 |
$0.00 |
| 96127 |
|
184 |
167 |
$0.00 |
| 90716 |
|
149 |
133 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
29 |
29 |
$0.00 |
| 90688 |
|
24 |
23 |
$0.00 |
| 90619 |
|
18 |
17 |
$0.00 |