| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
450 |
450 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
264 |
255 |
$15K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
145 |
145 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
340 |
331 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
153 |
145 |
$11K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
40 |
40 |
$4K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
37 |
37 |
$663.91 |
| 92551 |
|
86 |
86 |
$370.83 |
| 99173 |
|
95 |
94 |
$359.69 |
| 96127 |
|
43 |
40 |
$175.10 |
| 96160 |
|
12 |
12 |
$51.80 |
| 90686 |
|
170 |
170 |
$0.17 |
| 90670 |
|
12 |
12 |
$0.00 |
| 90651 |
|
12 |
12 |
$0.00 |
| 36416 |
|
32 |
32 |
$0.00 |