| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,279 |
1,913 |
$180K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
500 |
473 |
$62K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
395 |
377 |
$41K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
331 |
265 |
$28K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
168 |
142 |
$16K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
135 |
134 |
$16K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,347 |
1,109 |
$11K |
| 90686 |
|
276 |
268 |
$6K |
| 90677 |
|
46 |
44 |
$4K |
| 90648 |
|
75 |
67 |
$2K |
| D1206 |
Topical application of fluoride varnish |
37 |
30 |
$747.60 |
| 96127 |
|
153 |
153 |
$687.69 |
| 90651 |
|
24 |
24 |
$558.72 |
| 90656 |
|
24 |
22 |
$488.88 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
18 |
16 |
$447.76 |
| 90674 |
|
19 |
19 |
$419.04 |
| 0071A |
|
12 |
12 |
$405.00 |
| 90723 |
|
15 |
12 |
$302.64 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
12 |
12 |
$261.38 |
| 90661 |
|
13 |
12 |
$240.52 |
| 99000 |
|
14 |
14 |
$9.00 |