| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,149 |
3,362 |
$171K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,583 |
2,508 |
$72K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
4,275 |
3,201 |
$61K |
| D1351 |
Sealant - per tooth |
748 |
185 |
$27K |
| D1120 |
Prophylaxis - child |
389 |
384 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
398 |
393 |
$11K |
| D1206 |
Topical application of fluoride varnish |
402 |
397 |
$10K |
| 36415 |
Collection of venous blood by venipuncture |
2,429 |
1,715 |
$10K |
| H1000 |
Prenatal care, at-risk assessment |
601 |
576 |
$8K |
| 96127 |
|
557 |
533 |
$8K |
| 36416 |
|
337 |
294 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
54 |
39 |
$457.85 |
| 86580 |
|
114 |
100 |
$448.00 |
| 90651 |
|
45 |
45 |
$275.20 |
| 90734 |
|
37 |
37 |
$224.00 |
| 90715 |
|
14 |
14 |
$89.60 |
| D0601 |
|
112 |
107 |
$0.00 |
| D0602 |
|
34 |
34 |
$0.00 |