| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,012 |
1,655 |
$146K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,485 |
1,983 |
$112K |
| 99215 |
Prolong outpt/office vis |
169 |
149 |
$12K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
130 |
122 |
$9K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
112 |
87 |
$9K |
| 99460 |
|
154 |
104 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
61 |
61 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
35 |
34 |
$3K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
92 |
87 |
$3K |
| 81002 |
|
648 |
575 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
37 |
26 |
$1K |
| 54150 |
|
12 |
12 |
$930.00 |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$624.00 |
| 90686 |
|
74 |
52 |
$441.52 |
| 90670 |
|
32 |
24 |
$195.84 |