| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
673 |
616 |
$70K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
865 |
779 |
$62K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
367 |
359 |
$38K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
359 |
348 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,489 |
1,380 |
$35K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
690 |
665 |
$31K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
187 |
162 |
$17K |
| 90686 |
|
417 |
407 |
$9K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
77 |
73 |
$8K |
| 97803 |
|
349 |
334 |
$8K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
689 |
634 |
$6K |
| 92551 |
|
539 |
518 |
$5K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
187 |
186 |
$4K |
| 90700 |
|
174 |
170 |
$4K |
| 96127 |
|
783 |
755 |
$4K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
169 |
122 |
$3K |
| 90648 |
|
119 |
116 |
$3K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
185 |
171 |
$2K |
| 90713 |
|
89 |
85 |
$2K |
| 90670 |
|
71 |
68 |
$2K |
| 99173 |
|
533 |
513 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
27 |
27 |
$1K |
| 90685 |
|
31 |
31 |
$651.84 |
| 90633 |
|
28 |
28 |
$651.84 |
| 96160 |
|
146 |
142 |
$394.18 |
| 90651 |
|
14 |
14 |
$325.92 |
| 90680 |
|
15 |
12 |
$296.05 |
| 90744 |
|
12 |
12 |
$256.08 |
| 96161 |
|
51 |
43 |
$119.11 |