| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
584 |
521 |
$26K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
111 |
91 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
94 |
72 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
45 |
38 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
34 |
28 |
$3K |
| D1206 |
Topical application of fluoride varnish |
81 |
58 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
97 |
50 |
$2K |
| 96127 |
|
100 |
80 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
50 |
32 |
$835.64 |
| 90670 |
|
54 |
47 |
$755.82 |
| 99173 |
|
90 |
85 |
$670.50 |
| 90648 |
|
71 |
60 |
$533.75 |
| 90685 |
|
51 |
41 |
$486.86 |
| 90686 |
|
23 |
23 |
$356.53 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
22 |
18 |
$345.40 |
| 90723 |
|
21 |
17 |
$134.40 |
| 90461 |
|
23 |
16 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
25 |
18 |
$0.00 |