| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
892 |
687 |
$66K |
| 95930 |
|
793 |
690 |
$41K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
327 |
264 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
221 |
202 |
$14K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
127 |
114 |
$9K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
544 |
482 |
$9K |
| 92587 |
|
689 |
583 |
$9K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
131 |
109 |
$8K |
| 88738 |
|
784 |
674 |
$3K |
| 96127 |
|
155 |
136 |
$2K |
| 90686 |
|
182 |
154 |
$1K |
| 81002 |
|
429 |
395 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
69 |
69 |
$888.72 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$312.00 |
| 97802 |
|
115 |
107 |
$0.00 |
| 1036F |
|
75 |
57 |
$0.00 |
| 3511F |
|
48 |
30 |
$0.00 |
| 1003F |
|
278 |
191 |
$0.00 |