| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,351 |
2,030 |
$208K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,824 |
1,549 |
$109K |
| 99215 |
Prolong outpt/office vis |
479 |
428 |
$58K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
731 |
588 |
$57K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
532 |
483 |
$45K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
918 |
818 |
$34K |
| 99058 |
|
1,971 |
1,794 |
$33K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,756 |
1,537 |
$32K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
337 |
271 |
$29K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
183 |
169 |
$14K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
698 |
649 |
$9K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
494 |
458 |
$7K |
| 83718 |
|
842 |
695 |
$7K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,127 |
939 |
$4K |
| 96127 |
|
1,022 |
874 |
$4K |
| 96111 |
|
12 |
12 |
$1K |
| 85018 |
|
2,199 |
1,883 |
$1K |
| 82465 |
|
122 |
108 |
$580.27 |
| 92551 |
|
1,746 |
1,443 |
$538.72 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$414.60 |
| 92567 |
|
14 |
14 |
$190.96 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$183.00 |
| 90658 |
|
368 |
320 |
$25.24 |
| 99173 |
|
1,924 |
1,597 |
$0.00 |
| 90734 |
|
101 |
82 |
$0.00 |
| 90707 |
|
58 |
53 |
$0.00 |
| 90715 |
|
15 |
13 |
$0.00 |
| 90670 |
|
255 |
228 |
$0.00 |
| 90649 |
|
30 |
26 |
$0.00 |
| 90648 |
|
60 |
58 |
$0.00 |
| 90633 |
|
29 |
25 |
$0.00 |
| 90723 |
|
28 |
25 |
$0.00 |
| 90716 |
|
86 |
80 |
$0.00 |
| 90680 |
|
58 |
56 |
$0.00 |