| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,508 |
2,301 |
$113K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,107 |
1,066 |
$74K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
1,058 |
995 |
$74K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
972 |
962 |
$72K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
655 |
645 |
$48K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
302 |
296 |
$22K |
| 90723 |
|
610 |
562 |
$18K |
| 92587 |
|
378 |
368 |
$14K |
| 90707 |
|
273 |
267 |
$5K |
| 90670 |
|
851 |
799 |
$5K |
| 90648 |
|
832 |
781 |
$5K |
| 90686 |
|
690 |
657 |
$4K |
| D1206 |
Topical application of fluoride varnish |
215 |
211 |
$4K |
| 94010 |
|
136 |
133 |
$3K |
| 99051 |
|
262 |
255 |
$3K |
| 94664 |
|
191 |
189 |
$3K |
| 90633 |
|
379 |
365 |
$2K |
| 90696 |
|
86 |
86 |
$2K |
| 90681 |
|
302 |
277 |
$2K |
| 90716 |
|
276 |
269 |
$2K |
| 96161 |
|
590 |
549 |
$2K |
| 90715 |
|
77 |
75 |
$1K |
| 90651 |
|
204 |
197 |
$1K |
| 90700 |
|
55 |
55 |
$1K |
| 99460 |
|
13 |
13 |
$1K |
| 83655 |
|
68 |
68 |
$844.03 |
| 90734 |
|
115 |
111 |
$695.89 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
37 |
29 |
$580.51 |
| 90688 |
|
17 |
17 |
$91.53 |