| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
704 |
632 |
$36K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
448 |
369 |
$30K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
276 |
254 |
$22K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
238 |
161 |
$18K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
644 |
492 |
$11K |
| 96127 |
|
630 |
530 |
$9K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
68 |
58 |
$5K |
| D1206 |
Topical application of fluoride varnish |
175 |
108 |
$5K |
| 90671 |
|
261 |
180 |
$5K |
| 87428 |
|
73 |
72 |
$4K |
| 90697 |
|
223 |
184 |
$4K |
| 90680 |
|
218 |
163 |
$4K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
27 |
27 |
$1K |
| 90677 |
|
76 |
69 |
$1K |
| 90686 |
|
64 |
49 |
$1K |
| 83655 |
|
79 |
59 |
$948.80 |
| 99460 |
|
12 |
12 |
$753.12 |
| 90656 |
|
40 |
39 |
$671.43 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
57 |
42 |
$633.09 |
| 36416 |
|
100 |
81 |
$410.00 |
| 85018 |
|
170 |
119 |
$389.76 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
14 |
13 |
$219.80 |
| 90710 |
|
14 |
12 |
$217.23 |
| 87807 |
|
12 |
12 |
$112.57 |
| 90461 |
|
15 |
13 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
20 |
18 |
$0.00 |