| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
678 |
591 |
$28K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
680 |
671 |
$21K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
443 |
438 |
$20K |
| 92551 |
|
710 |
697 |
$10K |
| 92567 |
|
608 |
595 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
397 |
394 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
93 |
93 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
30 |
26 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
50 |
50 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
27 |
26 |
$702.00 |
| 99173 |
|
123 |
123 |
$615.00 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
26 |
26 |
$195.00 |
| 90686 |
|
64 |
64 |
$0.00 |