| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,718 |
2,597 |
$154K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,190 |
1,185 |
$43K |
| 92552 |
|
766 |
766 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
172 |
172 |
$13K |
| 99188 |
|
523 |
521 |
$10K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
230 |
225 |
$9K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
64 |
62 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
628 |
628 |
$4K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
561 |
553 |
$4K |
| D1206 |
Topical application of fluoride varnish |
154 |
152 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
44 |
44 |
$4K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
29 |
29 |
$2K |
| 92567 |
|
118 |
103 |
$2K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
63 |
62 |
$2K |
| 81002 |
|
850 |
849 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
109 |
78 |
$1K |
| 90461 |
|
12 |
12 |
$657.47 |
| 99173 |
|
540 |
538 |
$586.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
21 |
21 |
$578.49 |
| 99401 |
|
41 |
41 |
$476.02 |
| 87070 |
|
57 |
55 |
$433.62 |
| 87184 |
|
57 |
55 |
$292.68 |
| 96127 |
|
61 |
61 |
$155.02 |
| 99441 |
|
22 |
22 |
$121.09 |
| 90686 |
|
177 |
177 |
$0.02 |
| 90674 |
|
13 |
13 |
$0.00 |