| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,283 |
1,158 |
$85K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,090 |
2,794 |
$32K |
| G9920 |
Screening performed and negative |
926 |
926 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,128 |
1,119 |
$25K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
581 |
579 |
$12K |
| 90686 |
|
1,031 |
1,027 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,622 |
1,516 |
$10K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
494 |
494 |
$8K |
| 99429 |
|
322 |
320 |
$7K |
| 96127 |
|
981 |
853 |
$6K |
| 97802 |
|
147 |
147 |
$5K |
| 99188 |
|
193 |
186 |
$4K |
| 92552 |
|
1,696 |
1,692 |
$4K |
| 90670 |
|
215 |
215 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
76 |
75 |
$2K |
| 0071A |
|
47 |
45 |
$2K |
| 0072A |
|
43 |
43 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
18 |
18 |
$1K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
49 |
47 |
$1K |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
74 |
74 |
$1K |
| 90656 |
|
68 |
68 |
$728.55 |
| 0154A |
|
18 |
18 |
$720.00 |
| 90698 |
|
61 |
61 |
$664.92 |
| G0442 |
Annual alcohol misuse screening, 5 to 15 minutes |
25 |
25 |
$507.50 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
38 |
38 |
$427.44 |
| H0049 |
Alcohol and/or drug screening |
24 |
24 |
$291.38 |
| 90685 |
|
13 |
12 |
$178.16 |
| 90651 |
|
15 |
15 |
$161.91 |
| 90715 |
|
14 |
14 |
$152.91 |
| 90734 |
|
15 |
15 |
$152.91 |
| 90672 |
|
14 |
14 |
$152.21 |
| 90700 |
|
12 |
12 |
$130.77 |
| 90633 |
|
12 |
12 |
$130.77 |
| 90707 |
|
12 |
12 |
$128.70 |
| 86580 |
|
40 |
40 |
$16.52 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
41 |
40 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
68 |
67 |
$0.00 |