| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12,184 |
10,448 |
$115K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,271 |
4,094 |
$71K |
| D1206 |
Topical application of fluoride varnish |
3,362 |
3,261 |
$67K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,423 |
2,389 |
$38K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,595 |
1,586 |
$25K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
565 |
565 |
$24K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
707 |
704 |
$24K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,229 |
1,205 |
$21K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
864 |
864 |
$15K |
| 99173 |
|
3,336 |
3,317 |
$12K |
| 99188 |
|
586 |
584 |
$11K |
| 92551 |
|
2,981 |
2,965 |
$3K |
| 90686 |
|
2,167 |
2,156 |
$2K |
| 90648 |
|
879 |
866 |
$2K |
| 90670 |
|
930 |
911 |
$2K |
| 90723 |
|
534 |
531 |
$1K |
| 90680 |
|
218 |
217 |
$495.00 |
| 90633 |
|
299 |
290 |
$413.42 |
| 86580 |
|
136 |
129 |
$374.88 |
| 90710 |
|
450 |
440 |
$306.00 |
| 90620 |
|
56 |
56 |
$213.54 |
| 90651 |
|
319 |
318 |
$207.27 |
| 90715 |
|
176 |
175 |
$171.00 |
| 90696 |
|
124 |
124 |
$98.68 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$74.89 |
| 90655 |
|
85 |
85 |
$45.00 |
| 90734 |
|
121 |
121 |
$37.00 |
| 90656 |
|
41 |
41 |
$18.00 |
| 90685 |
|
13 |
13 |
$10.00 |
| 90688 |
|
17 |
17 |
$0.00 |