| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92552 |
|
375 |
375 |
$3K |
| D1206 |
Topical application of fluoride varnish |
197 |
196 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,473 |
1,409 |
$987.55 |
| 90686 |
|
47 |
45 |
$278.73 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
220 |
220 |
$130.23 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
250 |
244 |
$116.49 |
| 90688 |
|
99 |
99 |
$8.92 |
| 99173 |
|
552 |
551 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
108 |
107 |
$0.00 |
| G9920 |
Screening performed and negative |
586 |
586 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
110 |
108 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
81 |
81 |
$0.00 |
| 90670 |
|
14 |
13 |
$0.00 |
| 90685 |
|
13 |
13 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
25 |
25 |
$0.00 |
| 90698 |
|
13 |
12 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
104 |
104 |
$0.00 |
| 99172 |
|
13 |
13 |
$0.00 |