| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
6,379 |
5,686 |
$35K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,959 |
2,343 |
$30K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,893 |
4,544 |
$18K |
| 90674 |
|
825 |
822 |
$17K |
| D1206 |
Topical application of fluoride varnish |
288 |
287 |
$7K |
| 98926 |
|
120 |
67 |
$5K |
| 90686 |
|
437 |
437 |
$4K |
| 90715 |
|
46 |
46 |
$2K |
| 86580 |
|
213 |
208 |
$712.32 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
521 |
521 |
$305.14 |
| 90662 |
|
13 |
13 |
$282.38 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
474 |
474 |
$261.80 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
76 |
76 |
$216.00 |
| 90688 |
|
135 |
131 |
$147.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
1,325 |
1,323 |
$0.00 |
| 1036F |
|
533 |
532 |
$0.00 |
| G0442 |
Annual alcohol misuse screening, 5 to 15 minutes |
774 |
774 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
29 |
29 |
$0.00 |
| 90648 |
|
12 |
12 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
56 |
56 |
$0.00 |