| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
9,289 |
8,697 |
$648K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
3,563 |
3,546 |
$335K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
3,026 |
3,010 |
$282K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
3,091 |
3,038 |
$267K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,281 |
1,277 |
$136K |
| 92552 |
|
6,777 |
6,741 |
$132K |
| 90670 |
|
1,981 |
1,959 |
$25K |
| 90686 |
|
1,328 |
1,319 |
$22K |
| 90680 |
|
1,353 |
1,337 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
624 |
622 |
$16K |
| D9999 |
Unspecified adjunctive procedure, by report |
567 |
566 |
$14K |
| 90688 |
|
1,073 |
1,068 |
$13K |
| 99173 |
|
6,927 |
6,894 |
$12K |
| 90633 |
|
813 |
804 |
$11K |
| 90716 |
|
811 |
803 |
$10K |
| 90648 |
|
846 |
831 |
$9K |
| 99499 |
|
296 |
295 |
$8K |
| 90707 |
|
700 |
694 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
67 |
66 |
$7K |
| 90671 |
|
467 |
466 |
$7K |
| 90700 |
|
495 |
492 |
$6K |
| 99429 |
|
260 |
259 |
$6K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
155 |
153 |
$6K |
| 90651 |
|
401 |
400 |
$5K |
| 88738 |
|
922 |
914 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
45 |
45 |
$4K |
| 90697 |
|
235 |
235 |
$4K |
| 90723 |
|
257 |
252 |
$3K |
| 90734 |
|
165 |
165 |
$2K |
| D1206 |
Topical application of fluoride varnish |
144 |
143 |
$2K |
| 90698 |
|
70 |
69 |
$738.38 |
| 99188 |
|
40 |
39 |
$490.25 |
| 90713 |
|
27 |
27 |
$389.39 |
| 90715 |
|
32 |
32 |
$376.50 |
| 90744 |
|
12 |
12 |
$195.24 |
| 92551 |
|
12 |
12 |
$84.00 |
| 94760 |
|
377 |
363 |
$57.53 |