| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,268 |
994 |
$97K |
| D1206 |
Topical application of fluoride varnish |
1,341 |
1,336 |
$33K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
360 |
317 |
$30K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,488 |
1,292 |
$11K |
| 99381 |
|
67 |
63 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
58 |
43 |
$6K |
| 90686 |
|
126 |
118 |
$3K |
| 96161 |
|
171 |
151 |
$396.11 |
| 92551 |
|
45 |
37 |
$369.36 |
| 36415 |
Collection of venous blood by venipuncture |
162 |
142 |
$308.31 |
| 99173 |
|
48 |
39 |
$104.00 |