| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
2,369 |
1,971 |
$162K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
2,024 |
1,643 |
$155K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
844 |
784 |
$42K |
| 90698 |
|
1,471 |
1,231 |
$19K |
| 90677 |
|
289 |
246 |
$16K |
| 90670 |
|
1,055 |
928 |
$16K |
| 90686 |
|
945 |
829 |
$11K |
| D1206 |
Topical application of fluoride varnish |
378 |
219 |
$10K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
592 |
492 |
$10K |
| 90680 |
|
672 |
600 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
59 |
41 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
47 |
41 |
$4K |
| 90633 |
|
277 |
220 |
$3K |
| 90744 |
|
267 |
234 |
$3K |
| 90656 |
|
59 |
57 |
$985.89 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
77 |
74 |
$914.54 |
| 90661 |
|
49 |
48 |
$829.38 |
| 99460 |
|
12 |
12 |
$753.12 |
| 83655 |
|
62 |
41 |
$735.32 |
| 90685 |
|
19 |
16 |
$208.23 |
| 90707 |
|
12 |
12 |
$150.72 |
| 90716 |
|
12 |
12 |
$150.72 |
| 85018 |
|
47 |
24 |
$109.04 |
| 36416 |
|
21 |
13 |
$86.10 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
23 |
16 |
$0.00 |
| 90461 |
|
18 |
12 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$0.00 |