| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,705 |
9,738 |
$745K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,647 |
3,931 |
$436K |
| 99199 |
Unlisted special service, procedure or report |
67,213 |
44,699 |
$363K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,592 |
1,471 |
$130K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,091 |
956 |
$96K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,795 |
4,262 |
$91K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
921 |
810 |
$89K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
684 |
636 |
$63K |
| 99401 |
|
779 |
501 |
$25K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
1,742 |
788 |
$24K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,579 |
1,421 |
$16K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
155 |
131 |
$15K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
661 |
577 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
148 |
144 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
114 |
90 |
$4K |
| 81003 |
|
3,510 |
3,066 |
$4K |
| D1206 |
Topical application of fluoride varnish |
148 |
144 |
$2K |
| 85018 |
|
306 |
261 |
$602.51 |
| 92551 |
|
2,330 |
2,138 |
$523.47 |
| 90474 |
|
26 |
26 |
$503.04 |
| 99177 |
|
1,171 |
1,111 |
$60.03 |
| 90686 |
|
1,172 |
1,029 |
$56.51 |
| 90685 |
|
159 |
156 |
$0.01 |
| 90670 |
|
226 |
221 |
$0.00 |
| 99071 |
|
65 |
38 |
$0.00 |
| 90671 |
|
41 |
38 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| 90710 |
|
24 |
24 |
$0.00 |
| 3008F |
|
426 |
409 |
$0.00 |
| 90680 |
|
38 |
38 |
$0.00 |
| 90656 |
|
72 |
71 |
$0.00 |
| 90723 |
|
50 |
50 |
$0.00 |
| 99000 |
|
56 |
31 |
$0.00 |
| 90647 |
|
51 |
50 |
$0.00 |
| 36416 |
|
26 |
26 |
$0.00 |
| 90688 |
|
12 |
12 |
$0.00 |