| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,669 |
1,493 |
$131K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
580 |
563 |
$59K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
524 |
492 |
$57K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
321 |
279 |
$27K |
| D1206 |
Topical application of fluoride varnish |
811 |
587 |
$15K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
126 |
125 |
$12K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,035 |
991 |
$10K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
160 |
151 |
$8K |
| 90686 |
|
338 |
328 |
$7K |
| 96160 |
|
1,530 |
1,409 |
$7K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
1,137 |
983 |
$6K |
| 90461 |
|
506 |
462 |
$5K |
| 90698 |
|
268 |
246 |
$5K |
| 90670 |
|
231 |
214 |
$4K |
| 92551 |
|
349 |
345 |
$3K |
| 90633 |
|
158 |
152 |
$3K |
| 96127 |
|
386 |
380 |
$2K |
| 99177 |
|
317 |
312 |
$2K |
| 99401 |
|
37 |
36 |
$1K |
| 90744 |
|
56 |
50 |
$954.48 |
| 99188 |
|
171 |
165 |
$904.30 |
| 99173 |
|
286 |
283 |
$678.83 |
| 83655 |
|
54 |
54 |
$577.33 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
42 |
42 |
$517.45 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
33 |
27 |
$482.15 |
| 90710 |
|
26 |
24 |
$395.76 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
17 |
13 |
$384.94 |
| 96161 |
|
119 |
109 |
$273.94 |
| 99072 |
|
2,833 |
2,447 |
$231.00 |
| 85018 |
|
112 |
107 |
$216.81 |
| 99051 |
|
17 |
15 |
$199.64 |
| 99000 |
|
533 |
483 |
$45.00 |
| 36416 |
|
287 |
233 |
$22.00 |
| 3074F |
|
16 |
13 |
$0.00 |
| 3008F |
|
68 |
38 |
$0.00 |
| 1159F |
|
28 |
12 |
$0.00 |
| 1160F |
|
28 |
12 |
$0.00 |
| 3078F |
|
16 |
13 |
$0.00 |