| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,206 |
2,017 |
$88K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,354 |
1,267 |
$87K |
| 96111 |
|
1,017 |
997 |
$59K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
3,220 |
1,564 |
$49K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
496 |
491 |
$29K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
483 |
465 |
$25K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
211 |
211 |
$12K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
125 |
124 |
$8K |
| 99381 |
|
27 |
26 |
$2K |
| 92552 |
|
132 |
130 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
32 |
32 |
$588.31 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$189.00 |
| 94664 |
|
16 |
15 |
$157.60 |
| 90686 |
|
324 |
319 |
$39.01 |
| 90698 |
|
476 |
463 |
$0.00 |
| 90680 |
|
337 |
325 |
$0.00 |
| 90744 |
|
205 |
190 |
$0.00 |
| 90651 |
|
27 |
27 |
$0.00 |
| 90716 |
|
12 |
12 |
$0.00 |
| 90633 |
|
468 |
465 |
$0.00 |
| 90670 |
|
418 |
407 |
$0.00 |
| 90715 |
|
15 |
15 |
$0.00 |
| 90685 |
|
197 |
191 |
$0.00 |
| 90734 |
|
49 |
49 |
$0.00 |
| 90461 |
|
13 |
12 |
$0.00 |