| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
153 |
139 |
$9K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
58 |
58 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
56 |
52 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
93 |
91 |
$3K |
| D1206 |
Topical application of fluoride varnish |
208 |
195 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
13 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
59 |
51 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
41 |
37 |
$854.98 |
| 90686 |
|
13 |
13 |
$83.04 |
| 90670 |
|
13 |
12 |
$80.42 |