| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92081 |
|
893 |
891 |
$32K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,324 |
1,160 |
$27K |
| 97802 |
|
541 |
539 |
$18K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
107 |
103 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
168 |
155 |
$5K |
| 90680 |
|
303 |
297 |
$4K |
| D1206 |
Topical application of fluoride varnish |
169 |
166 |
$4K |
| 81000 |
|
776 |
773 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
399 |
397 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
120 |
117 |
$649.18 |
| 92552 |
|
925 |
923 |
$429.52 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
93 |
93 |
$180.56 |
| 90686 |
|
186 |
186 |
$140.94 |
| 90688 |
|
217 |
217 |
$89.20 |
| 90630 |
|
71 |
70 |
$49.60 |
| 90723 |
|
156 |
156 |
$0.00 |
| 90716 |
|
70 |
70 |
$0.00 |
| 85018 |
|
58 |
58 |
$0.00 |
| 90696 |
|
45 |
45 |
$0.00 |
| 90647 |
|
38 |
38 |
$0.00 |
| 90698 |
|
21 |
21 |
$0.00 |
| 90715 |
|
29 |
29 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
148 |
148 |
$0.00 |
| 90670 |
|
387 |
387 |
$0.00 |
| 90648 |
|
325 |
325 |
$0.00 |
| 90707 |
|
65 |
65 |
$0.00 |
| 90633 |
|
286 |
284 |
$0.00 |
| 90710 |
|
33 |
33 |
$0.00 |
| 90700 |
|
160 |
160 |
$0.00 |
| 90713 |
|
29 |
29 |
$0.00 |
| 90649 |
|
168 |
168 |
$0.00 |
| 90621 |
|
28 |
28 |
$0.00 |
| 90461 |
|
12 |
12 |
$0.00 |
| 90734 |
|
97 |
97 |
$0.00 |