| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
34 |
34 |
$1K |
| 92552 |
|
77 |
77 |
$896.75 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
25 |
25 |
$629.34 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
54 |
54 |
$543.50 |
| 90688 |
|
31 |
31 |
$279.00 |
| 99401 |
|
28 |
28 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
28 |
28 |
$0.00 |
| 97802 |
|
28 |
28 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
75 |
75 |
$0.00 |
| 3008F |
|
84 |
84 |
$0.00 |