| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,767 |
4,478 |
$195K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,447 |
2,719 |
$134K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
539 |
488 |
$39K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,432 |
1,184 |
$39K |
| 99401 |
|
1,559 |
1,235 |
$38K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
344 |
314 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,023 |
1,019 |
$19K |
| 90651 |
|
394 |
348 |
$15K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,211 |
1,095 |
$13K |
| D0190 |
|
992 |
988 |
$11K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
405 |
375 |
$9K |
| 81025 |
|
1,209 |
1,023 |
$6K |
| 36415 |
Collection of venous blood by venipuncture |
4,319 |
3,505 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
703 |
585 |
$5K |
| 96127 |
|
1,138 |
937 |
$5K |
| 90688 |
|
1,433 |
1,337 |
$4K |
| 92551 |
|
412 |
370 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
52 |
37 |
$3K |
| 0001A |
|
79 |
59 |
$2K |
| 99381 |
|
34 |
29 |
$2K |
| 99402 |
|
43 |
37 |
$2K |
| 90677 |
|
121 |
108 |
$2K |
| 90670 |
|
1,264 |
1,184 |
$2K |
| 0002A |
|
55 |
39 |
$2K |
| 90716 |
|
382 |
353 |
$1K |
| 90715 |
|
326 |
309 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
14 |
12 |
$1K |
| 99173 |
|
296 |
270 |
$818.30 |
| 90707 |
|
399 |
369 |
$779.63 |
| 90734 |
|
147 |
132 |
$647.46 |
| 36416 |
|
537 |
361 |
$604.11 |
| D1351 |
Sealant - per tooth |
50 |
13 |
$498.10 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$443.69 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
29 |
28 |
$414.40 |
| 90619 |
|
30 |
30 |
$388.29 |
| 94250 |
|
31 |
13 |
$353.87 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
13 |
12 |
$263.51 |
| 90710 |
|
48 |
48 |
$238.04 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
23 |
16 |
$198.91 |
| 90656 |
|
20 |
17 |
$184.99 |
| 90633 |
|
710 |
665 |
$183.19 |
| 90680 |
|
262 |
235 |
$155.20 |
| 90461 |
|
2,952 |
2,788 |
$135.12 |
| 90697 |
|
219 |
207 |
$132.31 |
| 85018 |
|
34 |
29 |
$89.04 |
| 90698 |
|
816 |
753 |
$82.64 |
| 90686 |
|
136 |
117 |
$75.00 |
| 90696 |
|
108 |
105 |
$47.17 |
| 90744 |
|
264 |
235 |
$22.02 |
| 99000 |
|
47 |
38 |
$0.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$0.00 |
| 91300 |
|
22 |
21 |
$0.00 |
| 90661 |
|
24 |
24 |
$0.00 |
| 90687 |
|
16 |
15 |
$0.00 |
| 90671 |
|
39 |
39 |
$0.00 |