| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
510 |
425 |
$30K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
638 |
545 |
$22K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
197 |
173 |
$10K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
138 |
127 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
57 |
56 |
$3K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
43 |
16 |
$1K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
68 |
48 |
$893.26 |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
50 |
$618.72 |
| 92551 |
|
30 |
30 |
$368.01 |
| 99173 |
|
12 |
12 |
$228.00 |
| 83655 |
|
12 |
12 |
$179.40 |
| 3008F |
|
16 |
16 |
$165.00 |
| 90686 |
|
46 |
46 |
$152.26 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
13 |
13 |
$112.19 |
| 85018 |
|
24 |
24 |
$70.69 |
| 36416 |
|
12 |
12 |
$36.36 |