| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,093 |
929 |
$80K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,087 |
909 |
$59K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
562 |
404 |
$36K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,433 |
1,246 |
$25K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
835 |
721 |
$17K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,153 |
1,005 |
$9K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
139 |
136 |
$8K |
| 90474 |
|
422 |
370 |
$7K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
70 |
69 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
86 |
85 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
175 |
70 |
$2K |
| 96161 |
|
411 |
401 |
$1K |
| D1206 |
Topical application of fluoride varnish |
86 |
85 |
$1K |
| 99051 |
|
13 |
12 |
$317.76 |
| 96127 |
|
36 |
36 |
$161.50 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
12 |
12 |
$155.43 |
| 85018 |
|
30 |
30 |
$2.92 |
| 90670 |
|
675 |
583 |
$0.00 |
| 90461 |
|
103 |
100 |
$0.00 |
| 99177 |
|
34 |
34 |
$0.00 |
| 90633 |
|
14 |
14 |
$0.00 |
| 90680 |
|
506 |
450 |
$0.00 |
| 90698 |
|
622 |
536 |
$0.00 |
| 90744 |
|
122 |
121 |
$0.00 |
| 90686 |
|
69 |
68 |
$0.00 |