| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
844 |
790 |
$49K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
119 |
117 |
$10K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
281 |
269 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
56 |
48 |
$4K |
| 92552 |
|
180 |
165 |
$4K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$416.58 |
| 99173 |
|
181 |
166 |
$357.64 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$300.60 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
14 |
14 |
$139.32 |
| 96127 |
|
75 |
70 |
$71.82 |
| 81002 |
|
46 |
36 |
$65.74 |
| 90716 |
|
12 |
12 |
$0.01 |
| 90707 |
|
12 |
12 |
$0.01 |
| 90686 |
|
50 |
46 |
$0.00 |
| 90670 |
|
12 |
12 |
$0.00 |