| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
560 |
528 |
$37K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
687 |
662 |
$22K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
172 |
165 |
$17K |
| D1206 |
Topical application of fluoride varnish |
237 |
237 |
$13K |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
311 |
279 |
$12K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
105 |
105 |
$11K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
92 |
92 |
$10K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
74 |
74 |
$8K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
61 |
61 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
109 |
109 |
$4K |
| 99401 |
|
94 |
94 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
195 |
190 |
$3K |
| 92015 |
Determination of refractive state |
139 |
139 |
$2K |
| 92567 |
|
158 |
151 |
$2K |
| 92587 |
|
86 |
86 |
$1K |
| 99188 |
|
93 |
93 |
$1K |
| 87999 |
|
217 |
200 |
$681.00 |
| 96127 |
|
101 |
101 |
$544.66 |
| 99058 |
|
25 |
25 |
$492.25 |
| 94664 |
|
30 |
28 |
$447.47 |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
26 |
26 |
$390.52 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
16 |
14 |
$389.32 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
30 |
30 |
$236.80 |
| 99177 |
|
17 |
17 |
$124.00 |
| 36416 |
|
27 |
27 |
$88.52 |
| 90670 |
|
15 |
15 |
$0.00 |
| 90685 |
|
34 |
34 |
$0.00 |
| 90672 |
|
77 |
77 |
$0.00 |
| 90700 |
|
24 |
24 |
$0.00 |
| 90688 |
|
97 |
97 |
$0.00 |
| 90686 |
|
191 |
191 |
$0.00 |