| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,277 |
2,329 |
$226K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,273 |
910 |
$79K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
974 |
707 |
$59K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,407 |
983 |
$36K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
577 |
414 |
$35K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
662 |
507 |
$31K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,128 |
1,469 |
$29K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
291 |
209 |
$19K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,917 |
1,357 |
$18K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,267 |
897 |
$13K |
| 99215 |
Prolong outpt/office vis |
186 |
109 |
$12K |
| 96127 |
|
2,628 |
1,836 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
320 |
235 |
$7K |
| 88738 |
|
920 |
708 |
$4K |
| D1206 |
Topical application of fluoride varnish |
334 |
235 |
$3K |
| 90474 |
|
182 |
125 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
61 |
47 |
$1K |
| 90734 |
|
210 |
127 |
$1K |
| 99383 |
|
16 |
15 |
$1K |
| 90651 |
|
77 |
51 |
$888.48 |
| 80061 |
Lipid panel |
50 |
41 |
$677.73 |
| 90715 |
|
143 |
84 |
$240.66 |
| 90686 |
|
509 |
330 |
$165.50 |
| 92552 |
|
1,137 |
818 |
$80.45 |
| 90707 |
|
283 |
204 |
$70.73 |
| 90696 |
|
77 |
70 |
$49.13 |
| 99173 |
|
1,182 |
849 |
$26.00 |
| 90723 |
|
297 |
195 |
$0.00 |
| 90716 |
|
276 |
195 |
$0.00 |
| 90680 |
|
184 |
124 |
$0.00 |
| 90648 |
|
493 |
363 |
$0.00 |
| 90670 |
|
511 |
363 |
$0.00 |
| 90633 |
|
249 |
159 |
$0.00 |