| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
625 |
536 |
$23K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
58 |
48 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
41 |
40 |
$2K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
104 |
98 |
$2K |
| D1206 |
Topical application of fluoride varnish |
104 |
103 |
$2K |
| 96127 |
|
257 |
237 |
$992.07 |
| 92551 |
|
147 |
137 |
$841.73 |
| 85018 |
|
221 |
205 |
$287.59 |
| 99173 |
|
159 |
147 |
$252.00 |
| 36416 |
|
226 |
209 |
$5.22 |
| D0190 |
|
57 |
57 |
$0.00 |
| 3008F |
|
251 |
236 |
$0.00 |
| 90686 |
|
51 |
51 |
$0.00 |