| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
204 |
189 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
318 |
296 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
174 |
145 |
$13K |
| D1206 |
Topical application of fluoride varnish |
63 |
63 |
$2K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
26 |
25 |
$482.10 |
| 96127 |
|
27 |
25 |
$467.20 |
| 90670 |
|
12 |
12 |
$281.91 |
| 90686 |
|
18 |
18 |
$128.38 |
| 36416 |
|
25 |
25 |
$102.50 |
| 94760 |
|
23 |
12 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
235 |
149 |
$0.00 |
| 90461 |
|
45 |
45 |
$0.00 |
| 99177 |
|
28 |
26 |
$0.00 |