| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
4,497 |
4,009 |
$104K |
| 96156 |
|
5,837 |
5,680 |
$30K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,096 |
3,943 |
$27K |
| 99460 |
|
2,318 |
2,280 |
$24K |
| 99462 |
|
3,242 |
2,413 |
$18K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,643 |
7,968 |
$12K |
| 99222 |
Initial hospital care, per day, moderate complexity |
761 |
739 |
$9K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
1,122 |
670 |
$8K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
424 |
391 |
$6K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
4,186 |
3,999 |
$2K |
| 90670 |
|
3,453 |
3,020 |
$2K |
| 90680 |
|
2,138 |
1,827 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
2,628 |
2,614 |
$1K |
| 90744 |
|
1,697 |
1,439 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,153 |
2,645 |
$830.74 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,037 |
1,034 |
$685.68 |
| 90677 |
|
189 |
178 |
$576.00 |
| 90698 |
|
317 |
250 |
$549.00 |
| D1206 |
Topical application of fluoride varnish |
5,082 |
4,848 |
$534.60 |
| 90700 |
|
3,409 |
3,154 |
$522.90 |
| 90713 |
|
2,556 |
2,360 |
$495.90 |
| 90648 |
|
2,527 |
2,270 |
$441.00 |
| 92551 |
|
5,268 |
5,221 |
$434.95 |
| 90688 |
|
1,210 |
1,186 |
$389.00 |
| 90651 |
|
656 |
643 |
$238.82 |
| 90685 |
|
851 |
743 |
$237.84 |
| 90707 |
|
1,622 |
1,543 |
$135.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,631 |
1,419 |
$119.80 |
| 85018 |
|
8,544 |
8,268 |
$110.49 |
| 90716 |
|
1,589 |
1,527 |
$81.00 |
| 90633 |
|
1,273 |
1,224 |
$54.00 |
| 90686 |
|
1,715 |
1,704 |
$54.00 |
| 86580 |
|
1,128 |
1,076 |
$45.33 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
441 |
441 |
$42.55 |
| 96127 |
|
312 |
308 |
$28.56 |
| 90734 |
|
82 |
82 |
$18.00 |
| 99173 |
|
5,158 |
5,110 |
$5.02 |
| 99188 |
|
735 |
723 |
$0.00 |
| 99238 |
Hospital discharge day management, 30 minutes or less |
14 |
12 |
$0.00 |
| 90715 |
|
48 |
48 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
174 |
174 |
$0.00 |