| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,236 |
1,110 |
$100K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
769 |
745 |
$84K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
46 |
46 |
$5K |
| 90686 |
|
154 |
153 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
328 |
322 |
$3K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
16 |
16 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
12 |
12 |
$1K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
47 |
43 |
$1K |
| 99173 |
|
263 |
259 |
$671.94 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
31 |
22 |
$565.88 |
| 96127 |
|
52 |
52 |
$240.21 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
14 |
14 |
$183.96 |