| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,725 |
1,365 |
$70K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
221 |
192 |
$7K |
| D1206 |
Topical application of fluoride varnish |
259 |
259 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
175 |
163 |
$4K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
279 |
230 |
$2K |
| D0190 |
|
246 |
246 |
$2K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
74 |
64 |
$1K |
| 96127 |
|
398 |
330 |
$1K |
| 0011A |
|
41 |
28 |
$1K |
| 90688 |
|
214 |
192 |
$820.00 |
| 36415 |
Collection of venous blood by venipuncture |
470 |
407 |
$507.46 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$341.30 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
60 |
49 |
$310.65 |
| 99173 |
|
19 |
13 |
$40.10 |