| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
1,634 |
1,329 |
$124K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,182 |
981 |
$81K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
614 |
589 |
$30K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
373 |
334 |
$28K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
184 |
156 |
$13K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
739 |
663 |
$12K |
| 90686 |
|
1,053 |
945 |
$11K |
| 90670 |
|
566 |
487 |
$7K |
| 90698 |
|
586 |
492 |
$5K |
| D1206 |
Topical application of fluoride varnish |
119 |
105 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
185 |
159 |
$2K |
| 90677 |
|
37 |
25 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
29 |
24 |
$2K |
| 0072A |
|
30 |
30 |
$1K |
| 90661 |
|
74 |
71 |
$1K |
| 0071A |
|
29 |
29 |
$1K |
| 90633 |
|
112 |
90 |
$1K |
| 90656 |
|
52 |
47 |
$882.42 |
| 90744 |
|
80 |
52 |
$813.47 |
| 90710 |
|
54 |
40 |
$623.97 |
| 90680 |
|
89 |
80 |
$563.20 |
| 90685 |
|
46 |
35 |
$338.02 |
| 99000 |
|
12 |
12 |
$264.12 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
16 |
16 |
$0.00 |
| 99177 |
|
12 |
12 |
$0.00 |