| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
975 |
809 |
$76K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
308 |
269 |
$37K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
631 |
576 |
$23K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
156 |
125 |
$18K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
147 |
129 |
$16K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
96 |
91 |
$11K |
| 92587 |
|
308 |
294 |
$10K |
| 96127 |
|
285 |
268 |
$7K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
192 |
165 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
18 |
14 |
$403.00 |
| 36416 |
|
108 |
99 |
$340.06 |
| D1206 |
Topical application of fluoride varnish |
18 |
14 |
$322.40 |
| 85018 |
|
128 |
115 |
$9.04 |
| 90686 |
|
274 |
259 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |
| 99000 |
|
24 |
13 |
$0.00 |
| 90670 |
|
74 |
66 |
$0.00 |
| 90633 |
|
15 |
13 |
$0.00 |