| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,556 |
1,339 |
$51K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
259 |
253 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
110 |
92 |
$5K |
| D1206 |
Topical application of fluoride varnish |
204 |
204 |
$4K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
151 |
119 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
301 |
276 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
55 |
55 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
17 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
40 |
40 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
641 |
573 |
$926.55 |
| D0190 |
|
93 |
93 |
$888.00 |
| 92551 |
|
65 |
58 |
$480.44 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
34 |
29 |
$222.93 |
| 99173 |
|
81 |
73 |
$191.26 |
| 90688 |
|
178 |
173 |
$190.00 |
| 90461 |
|
32 |
31 |
$0.00 |