| Code | Description | Claims | Beneficiaries | Total Paid |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,733 |
1,420 |
$128K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,522 |
1,272 |
$72K |
| 92582 |
|
1,243 |
879 |
$38K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,542 |
1,280 |
$30K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
408 |
316 |
$29K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
297 |
196 |
$21K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
217 |
175 |
$16K |
| 99173 |
|
1,455 |
1,077 |
$11K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
146 |
132 |
$10K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
395 |
348 |
$10K |
| 90686 |
|
558 |
450 |
$4K |
| 81000 |
|
1,420 |
1,089 |
$4K |
| D1206 |
Topical application of fluoride varnish |
88 |
82 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
74 |
72 |
$2K |
| 90651 |
|
83 |
52 |
$2K |
| 86580 |
|
254 |
215 |
$1K |
| 92583 |
|
65 |
63 |
$954.45 |
| 90700 |
|
104 |
94 |
$885.60 |
| 90734 |
|
111 |
65 |
$828.35 |
| 90670 |
|
25 |
25 |
$786.46 |
| 90685 |
|
59 |
41 |
$364.80 |
| 83655 |
|
29 |
24 |
$343.94 |
| 90648 |
|
25 |
25 |
$223.90 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
13 |
13 |
$204.10 |
| 90713 |
|
13 |
13 |
$170.74 |
| 85018 |
|
54 |
49 |
$125.28 |
| 36416 |
|
30 |
25 |
$123.00 |
| 85014 |
|
30 |
25 |
$69.60 |
| 3008F |
|
638 |
377 |
$0.00 |
| 1036F |
|
251 |
142 |
$0.00 |
| 3351F |
|
153 |
76 |
$0.00 |
| 97803 |
|
153 |
135 |
$0.00 |
| 1003F |
|
615 |
365 |
$0.00 |
| 99072 |
|
113 |
90 |
$0.00 |