| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
125 |
106 |
$4K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
34 |
32 |
$2K |
| 3008F |
|
87 |
79 |
$858.00 |
| 92551 |
|
66 |
60 |
$807.00 |
| 99173 |
|
44 |
39 |
$745.18 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
13 |
12 |
$731.76 |
| 99000 |
|
86 |
68 |
$324.48 |
| 90686 |
|
77 |
69 |
$268.45 |
| 81003 |
|
65 |
60 |
$187.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
12 |
$163.92 |